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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 (subcutaneousintramuscularlyintravenous) External use ( eye drops 、 nasal drops)

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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?

slide6
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
slide9
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

slide11
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
slide15
Fixed

erythema

slide16
Fixed

erythema

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

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
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

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

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