Toxic necrotic epidermolysis drug eruption
Introduction
Introduction to toxic necrotic epidermolysis type drug eruption A drug used for prevention, diagnosis, and treatment, which causes skin and/or mucosal damage caused by any means of entering the body, which is called a drug rash. For the common diseases in dermatology emergency, toxic epidermal necrotic drug eruption is a kind of severe skin disease with multiple system damage. A drug rash characterized by large damaged areas and high mortality. Most drugs have the potential to cause drug eruptions, including Chinese herbal medicines, but most of them are caused by more antigenicity. Mostly sulfonamides, salicylates, phenylbutazone, aminopyrine and other antipyretic analgesics, phenolphthalein, penicillin, tetracycline, barbital, phenytoin and so on. In addition, for patients with congenital allergic diseases and patients with diseases of vital organs, the risk of drug eruption is relatively high. basic knowledge The proportion of illness: 0.003% Susceptible people: no specific population Mode of infection: non-infectious Complications: drug rash skin disease
Cause
Toxic necrotizing epidermolysis drug eruption cause
Most drugs have the possibility of causing drug eruption, including Chinese herbal medicines, but most of them are caused by more antigenicity, mostly sulfonamides, salicylates, phenylbutazone, aminopyrine and other antipyretic analgesics. , phenolphthalein, penicillin, tetracycline, barbital, phenytoin, etc. In addition, for patients with congenital allergic diseases and diseases of vital organs, the risk of drug eruption is relatively large.
Prevention
Toxic necrotizing epidermal release drug eruption prevention
Drug eruptions are iatrogenic diseases, so you must pay attention to:
1. Patients should be asked about the history of allergies before using the drug, avoiding the use of drugs known to be allergic or structurally similar.
2. Drugs should be targeted, try to use less sensitizing drugs, treatment should pay attention to the early symptoms of drug eruption, such as sudden itching, erythema, fever and other reactions, should immediately stop suspicious drugs, close observation and strive to determine sensitizing drugs.
3. When applying penicillin, serum, procaine and other drugs, skin test should be carried out according to the prescribed method. Positive patients should not be treated with this drug. Before the skin test, emergency medicine should be prepared for emergency needs. It is penicillin 500u/ml, streptomycin 5mg/m1, procaine 0.25%, tetanus antitoxin 1:10, and the dosage is 0.1m1.
4. If the drug rash has been diagnosed, the sensitizing drug should be recorded in the medical record and the patient should be kept in mind. Tell the doctor not to use the drug every time you see a doctor.
Complication
Toxic necrotizing epidermolysis drug eruption Complications, drug rash, skin disease
Heart, kidney, liver, brain are also often affected, the prognosis is serious, the mortality rate is 25% to 50%, mostly due to secondary infection, liver and kidney dysfunction, water and electrolyte disorders and death, severe cases often due to secondary infection, liver and kidney function Obstruction, electrolyte imbalance or visceral hemorrhage and proteinuria or even azotemia and other deaths.
Symptom
Toxic necrotizing epidermolysis type drug eruption symptoms Common symptoms Irritating epidermis full-thickness necrosis and ... Secondary infections sleepiness convulsions high fever coma shock
Toxic necrotizing epidermolysis drug eruption (TEN) is the most severe drug eruption, which is usually seen in the emergency department.
1. Initiation of drugs such as sulfonamides, salicylates, phenylbutazone, aminopyrine and other antipyretic analgesics, phenolphthalein, penicillin, tetracycline, barbital, phenytoin and so on.
2. The clinical manifestations are acute, accompanied by high fever, irritability, lethargy, convulsions, coma and other obvious symptoms of systemic poisoning. The skin manifests as full-thickness of the epidermis and formation of subepidermal bullae. At the beginning, it is a large piece of reddish patch, followed by purple-brown, 1 ~ 2 days, the blister appeared on the plaque and expanded, the sub-synthesis was several tens of centimeters in size, showing most parallel strip-like ridges, the big blister was easily rubbed and there was a large smash, similar to the second degree scald, Nilolsky sign (10), At the same time, the mouth, eyes, nose, upper respiratory tract, genitals, esophageal mucosa, can be widely affected, a large erosion surface appears after mucosal shedding, pain is extremely high, body temperature often lasts at 40 ° C up and down, 2 to 3 weeks does not retreat, heart The kidney, liver, and brain are often involved, and the prognosis is serious. The mortality rate is 25% to 50%, mostly due to secondary infection, liver and kidney dysfunction, and water and electrolyte disorders.
Examine
Examination of toxic necrotic epidermolysis drug eruption
Routine inspection:
1. Blood routine.
2. Urine routine.
3. Biochemical items. When anemia occurs, the peripheral blood picture shows a decrease in red blood cell count and hemoglobin; in concurrent infection, peripheral blood leukocyte count and neutrophil count are significantly increased; when severe infection is accompanied by water and electrolyte disorders, blood sodium, potassium, and chlorine should be used. pH and liver and kidney function tests.
4. Immunofluorescence antigen localization showed that in EBS, bullous pemphigoid serum, type IV collagen antibody and platein antibody were on the dermis side; in JEB, bullous pemphigoid serum was on the epidermis side, The type IV collagen antibody and the plate antibody are on the dermis side; in the DEB, the bullous type pemphigoid serum, the type IV collagen antibody, and the plate antibody are on the epidermis side.
In addition, electron microscopy also showed that in the upper part of the dermis of most DEB, there is a different amount of collagen dissolved. In neonatal transient bullous skin lysis, an amorphous stellate body is seen in the nucleus of the basal cell.
5. Severe cases should be chest X-ray, ECG, B-ultrasound and other examinations.
Diagnosis
Diagnosis and diagnosis of toxic necrotic epidermolysis drug eruption
diagnosis
Diagnosis can be based on medical history, clinical symptoms, and laboratory tests.
Differential diagnosis
Need to be differentiated from toxic shock syndrome.
