D rug eruption
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D rug Eruption. Definition. Drug eruption : various kinds of drugs delivered into human body by kinds of means create the cutaneous and mucosal reaction. Drugs delivered by kinds of means. Oral Injections (subcutaneous\intramuscularly\intravenous) External use ( eye drops 、 nasal drops)

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D rug Eruption

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D rug eruption

Drug Eruption


Definition

Definition

Drug eruption :various kinds of drugs delivered into human body by kinds of means create the cutaneous and mucosal reaction.


Drugs delivered by kinds of means

Drugs delivered by kinds of means

  • Oral

  • Injections (subcutaneous\intramuscularly\intravenous)

  • External use ( eye drops、nasal drops)

  • Inhalation

  • Buccal

  • Gargle

  • Embolism( anus suppository、pessary)

  • Coloclysis


Medicines causing the drug reaction

Medicines causing the drug reaction

  • 80’s~90’s

  • Antibiotic

  • Antipodagrics

  • Nonsteroidal antiinflammatatoyr agents

  • Sulfa-drugs

50’s~60’s

Sulfa-drugs

Antipyretic analgesic

Antibiotic

Hypnotics


Pathogensis

Pathogensis

Skin testing is negtive, why does the drug still cause the reaction?

The drug was discontinued a week ago, why do the eruptions appear now?

Penicilin did not cause reactions before, why am I allergic to it now ?

Why?


D rug eruption

No reaction

readministration

A new drug

Normal

human

No eruption

Severe eruption n

hypersensitivity

within24h

4~20days later

eruption


Pathogenesis

Pathogenesis

Hypersensitiveness

human

Special allergic reaction

??

drug

Antigenicity


Characteristic of allergic reaction

Characteristic of allergic reaction

  • Has a certain incubation period

  • Associated with humoral or cell-mediated immune

  • Readministration, eruption recur

  • Cross-reaction

  • Skin sensitivity test is positive

  • Indurate or desensitize

  • Steroid and antihistamine are effective


D rug eruption

  • Incubation period:from the day of contacting antigen to that of eruption appearing

  • First exposure to the medication : eruptions appear an average of 7~9d (3~20days) after the drug is started

  • Readministration,eruptions appear an average10h( few minutes -24h) after the drug is started


Clinical manifestation

Clinical manifestation

Incubation period

The onset and evolution of the eruptions

Clinical morphology

Course

Different clinical types

Depended on


D rug eruption

Two typical drug eruptions

Vulgary

  • (一)

  • (二)

Exfoliative dermatitis


Clinical feature of vulgary drug eruption

Clinical feature of vulgary drug eruption

  • Incubation period:4~20days

  • An acute onset of the disease

  • Eruptions spread from face to trunk, extremities, and are symmetrical, general

  • Courses are 2~4 weeks, eruptions may clear if the medicine discontinues


Clinical morphology of vulgary drug eruption

Clinical morphology of vulgary drug eruption

  • Fixed eyrthema

  • Toxic epidermal necrolysis

  • Scarlatiniform eyrthema

  • Morbilliform erythema

  • Erythema multiform

  • Urticaria

  • Pityriasis rose

  • Purpuric


Clinical feature of fixed erythema

Clinical feature of fixed erythema

  • Fixed

  • One or several,if recur ,eruption may be increased, enlarged

  • Favorite site at oral, genital mucosa

  • Eruptions are round or elliptic prunosus macule associated with edema

  • Prolonged or permanent postinflammatory hyperpigmentation


D rug eruption

Fixed

erythema


D rug eruption

Fixed

erythema


D rug eruption

Fixed erythema


D rug eruption

Fixed erythema


D rug eruption

Morbilliform erythema


D rug eruption

Morbilliform erythema


D rug eruption

Urticaria Drug eruption


D rug eruption

Pityriasis rosea drug eruption


Clinical feature of toxic epidermal necrolysis drug eruption

Clinical feature of toxic epidermal necrolysis drug eruption

Mucosal surface are eroded

Severe constitutional symptoms are often associated with high fever

Internal organ involvement

Coures: 3~4weeks

Skin lesions rapidly spread

Lesions are macule or purpuric centers form bullae slough


D rug eruption

Epidermal necrolysis drug eruption


D rug eruption

Epidermal necrolysis drug eruption


D rug eruption

Erythema multiform drug eruption


D rug eruption

Stevens-Johnson syndrome drug eruption


Clinical feature of exfoliative dematitis eruption

Clinical feature of exfoliative dematitis eruption

  • Has a long incubation period, often over 20days

  • The symptoms are progressively severe

  • The diffuse and generalized red macules associated edema, scaly obviously

  • Has constitutional symptoms

  • Long course ,for 1~3months or longer


D rug eruption

Exfoliative dematitis eruption


Diagnose

Diagnose

  • History of administration

  • Incubation period

  • Onset:acute or progressively worse

  • Eruption:morphology,distribution and number

  • Have or no systemic symptom

  • Course and prognosis

  • Skin testing and reexposure test:cautiously evaluate


Diagnose1

Diagnose

Drug eruption must be differentiated from

But sometime it is difficult to discriminate

Infetious disease

Related dermatoses


Diagnose2

Diagnose

Morbilliform drug eruption

Scarlatiniform drug eruption

Morbilli

Scarlatina

Differentiated

from


D rug eruption

Koplic macule


D rug eruption

Strawberry tongue


Differential diagnosis

Differential diagnosis

Erythema multiform drug eruption

Pityriasis rosea drug eruption

Urticarial drug eroption

Erythema multiform

Pityriasis rosea

Urticaria

Differe

ntIated

from


Prophylaxis

Prophylaxis

  • A detailed history from the patient

  • Be familiar with the structure of drugs, prevent cross-react

  • No drug abusing,know of medication indicatio

  • Pay attention to the signs of portent reaction


Treatment

Treatment

  • Stop the suspected drugs immediately

  • General measure: keep warm, strengthen nutrition and egestion.

  • Drugs: anti-allergy, supportive treatment and prevent secondary infections


Drug treatment

Drug treatment

  • Mild drug eruptione: antihistamine(may be various combinations),topical application of antipruritic powder or lotion

  • Moderately severe drug eruption:steroid :prednisone ---dose:30~40mg/d, then reduce the dose according to the symptom

  • severe forms:take measures as follows:


Treatment of severe drug eruption

Treatment of severe drug eruption

  • Corticosteroid:intravenous use: hydrocortisone 200-500mg/d

  • Supportive treatment:blood transfusion/ medium molecular dextran/ plasma adequate fluid intake

  • Prevent secondary infections: antibiotic treatment

  • Pay attention to the fluid and electrolyte balance, especially , especially to sylvite

  • Treatment to the internal involved

  • Topical treatment


Topical treatment

Without oozing

oozing

Powder \ lotion

compresses

acute

Without oozing

oozing

emulsion \ lotion

paste

subacute

Topical treatment:

skin

mucous membrane strengthen nurse of cavity, prevent complication


D rug eruption

Thanks


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