口服青霉素类药物所致药疹37例临床分析

回顾分析了37例口服青霉素所致药疹,其中猩红热样或麻疹样发疹型27例,荨麻疹型5例,多形红斑型 3例,麻疹样发疹型与紫癜混合型1例,固定药疹与麻疹样发疹混合型1例。6例肝功异常,1例心电图异常,1例血常规 异常,2例尿常规异常。平均住院8.32±4.03天。     

518例住院药疹患者致病药物临床分析

对518例住院药疹的致病药物进行临床分析，引起或可能引起的药物有20余类，致病药物中以抗感染药居首位，其他依次为解热镇痛药，抗痛风药，抗癫痫药，生物制品及消炎抗风湿药等。多形红斑型药疹是最常见的药疹类型，其次是荨麻疹型等。绝大多数致病药物所致的药疹以及多形红斑型最多见，抗痛风药和抗癫痫药多引起重症药疹，呋喃唑酮，破伤风抗毒素，狂犬疫苗引起荨麻疹型药疹。     

氨苯砜超敏反应综合征5例临床分析

目的探讨氨苯砜超敏反应综合征的临床特征和治疗方法。方法回顾分析5例氨苯砜超敏反应综合征临床资料。结果5例氨苯砜超敏综合征用药潜伏期较长,为20～42天,均以发热或皮疹为首发症状,皮疹呈多形性,为麻疹样型、多形红斑型和红皮病型,所有患者均有浅表淋巴结肿大,肝肿大,1例脾肿大,并伴有血液学异常和肝功能受损,治疗时间平均58天,4例痊愈出院,1例死于肺部感染。结论氨苯砜超敏综合征表现为发热、皮疹、黄疸、淋巴结肿大、肝损害和溶血性贫血。根据DDS用药史,排除微生物感染和其他发疹性疾病可诊断本病,治疗应遵循重症药疹治疗原则。     

马血清破伤风抗毒素与马破伤风免疫球蛋白F（ab′）2引起的皮肤迟发型变态反应临床分析

【摘要】 目的 观察马血清破伤风抗毒素（TAT）和马破伤风免疫球蛋白F（ab′）2注射后引起的皮肤迟发型变态反应,总结患者的临床特征与处理方法。方法 回顾性分析2008—2020年门诊与住院治疗的181例注射TAT或马破伤风免疫球蛋白后出现皮肤迟发型变态反应者的临床资料。结果 所有患者注射TAT或马破伤风免疫球蛋白前均行皮试检查,阴性171例（94.47%）,阳性10例（5.53%,行脱敏注射）。181例中男118例,女63例,年龄11 ~ 68岁,病程1 ~ 7 d,潜伏期4 ~ 14 d。注射TAT（130例）和马破伤风免疫球蛋白（51例）两组患者的临床表现无显著差异,以荨麻疹样皮疹为主,12例注射部位发生浸润性红斑,其中10例伴有全身荨麻疹。181例中皮疹泛发全身者163例（90.06%）,伴有胸闷、发热等系统症状者56例（30.94%）,其中15例（26.79%）既往有过敏史,6例症状较重的患者无过敏史。34例（18.78%）出现白细胞计数升高、C反应蛋白升高或尿隐血、尿糖等异常中的单一或多项。抗组胺药与糖皮质激素治疗有效,疗程3 ～ 10 d,转归良好。结论 TAT或破伤风免疫球蛋白皮试阴性或脱敏治疗的患者仍有可能出现皮肤迟发型变态反应,且以荨麻疹样皮疹为主。     

305例药疹致敏药物与皮疹类型分析

目的探讨药疹常见致敏药物、皮疹类型及其相互关系。方法回顾性分析本科305例住院患者临床资料。结果致敏药物抗生素居首位占26.89%;皮疹类型以麻疹样发疹型最多占30.16%。结论药疹主要致敏药物是抗生素、生物制品和解热镇痛药;皮疹类型主要是麻疹样发疹型、荨麻疹型和大疱性表皮松解萎缩坏死型;生物制品均引起荨麻疹型药疹,别嘌呤醇引起重型药疹较多。     

别嘌呤醇药疹12例临床分析

我科于 1991年 6月～ 2 0 0 0年 2月 ,共诊治别嘌呤醇药疹 12例 ,现作回顾性分析如下。临床资料　 12例中 ,男 10例 ,女 2例。年龄 5 2～ 74岁 ,平均 6 1.9岁。发病前均有明确的服用别嘌呤醇药物史。潜伏期 :19～ 42天不等 ,平均 2 5 .2天。其中 :大疱性表皮松解坏死型 1例 ,剥脱性皮炎型 4例 ,重症多形红斑型 3例 ,麻疹样及猩红热样发疹型各 2例。伴发热 1例 (38.2～ 39.8℃ ) ,粘膜损害 5例 ,肝损害 4例 ,肾损害 2例 ,肝、肾同时损害者 1例。全部病例血白细胞总数均增高 ,2例超过 2 0× 10 9 Ｌ。并发症与转归　肺部感染 2例 ,口腔念珠菌…     

抗菌药物致药疹22例

本文报道抗菌药物致药疹22例,其中40岁以上者12例;p内酰胺类抗生素药疹18例;药疹类型以发疹型(6例)和多形红斑型(6例)为主。     

小儿药疹103例分析

临床资料　１０３例小儿药疹，男５１例，女５２例。年龄１８天～１３岁。其中新生儿３例，婴儿１８例，幼儿１７例，学龄前３３例，学龄３２例。原发疾病以上呼吸道感染居多（４６．５％），其次为支气管炎（９．５％）。致敏药物包括氨苄青霉素２３例，青霉素２０例，解热镇痛类药２０例，磺胺类１１例，痢特灵１０例，其它９例。皮疹类型：荨麻疹型４８例，麻疹样或猩红热样型４７例，多型红斑型７例，固定性药疹１例。潜伏期０．５ｈ～１７天，３天以内者占５７．３％。伴发症状：发热４０例，腹痛、呕吐５例，关节痛２例。血白细胞增多…     

氨苄青霉素药疹106例分析

我科从1992年5月～1995年4月共诊治氨苄青霉素药疹106例,报告如下。临床资料　共106例,男36例,女70例,年龄1～70岁。有变态反应病史38例,包括支气管哮喘、过敏性鼻炎、荨麻疹、湿疹及磺胺、阿斯匹林、普鲁卡因药物过敏等。给药途径:静脉注射者89例,肌注9例,口服8例。潜伏期:用药后发病时间4～6h5例,2～3天19例,7～10天为76例,4～20天6例。疹型:以麻疹样红斑43例,猩红热样红斑32例,荨麻疹16例,皮肤划痕症6例,多形性红斑、过敏性紫癜、固定型药疹各3例。全部病例均有不同程度瘙痒,部分病例皮肤烧灼及疼痛感。伴发热21例(19.8%),其他分别伴有咽…     

住院药疹922例临床分析

目的 探讨药疹的发病趋势、致敏药物、疹型的变迁和防治方法。 方法 回顾分析复旦大学附属华山医院皮肤科2009年1月至2013年12月间收治的922例确诊药疹患者的临床资料。 结果 2009—2013年每年药疹病例占皮肤科同期住院总病例比例波动于9.45% ~ 10.01%,重症药疹占药疹比例波动于17.45% ~ 28.24%。单一用药371例（40.2%）,混合用药551例（59.8%）。278例单一用药非重症药疹中排名前5位的致敏药物依次为中药（72例）、头孢菌素类（38例）、阿莫西林（27例）、解热镇痛（26例）、破伤风抗毒素（24例）;93例单一用药重症药疹中排名前5位的致敏药物依次为抗癫痫药（33例）、别嘌醇（28例）、解热镇痛药（7例）、头孢菌素类（6例）、中药（6例）。922例患者中,皮疹类型主要为发疹型（422例,45.8%）、荨麻疹型（259例,28.1%）、重症多形红斑型（135例,14.6%）、中毒性表皮坏死松解症（49,5.3%）,另外共确诊药疹伴嗜酸性粒细胞增多和系统症状综合征（DRESS）33例（3.6%）、急性泛发性发疹性脓疱病7例（0.8%）。共791例（85.8%）药疹患者接受了糖皮质激素治疗,以等量泼尼松计算,非重症型药疹（550例）用量为（47.61 ± 12.07） mg/d,重症型药疹（221例）用量为（73.10 ± 18.23） mg/d。共有101例（11.0%）药疹患者因为糖皮质激素治疗后病情控制不佳联合使用静脉注射丙种球蛋白治疗。224例重症药疹中仅2例（0.9%）死亡。 结论 卡马西平和别嘌醇仍是引起重症药疹的首要致敏药物;在非重症药疹中中药为第1位致敏药物。2009—2013年重症药疹的死亡率明显下降。     

Patch testing in cutaneous reactions caused by carbamazepine

The usefulness of patch testing in the diagnosis of carbamazepine-induced allergic skin eruptions was studied in 18 patients with previous histories of skin eruptions caused by carbamazepine. The etiological role of carbamazepine was ascertained by peroral or topical provocation in 15 (out of 18) patients. The clinical reactions caused by the drug were classified as maculopapular exanthema with general symptoms (7 patients), other type of exanthema (3). exfoliative dermatitis (erythroderma) (3), fixed drug eruption (3), erythema multiforme (1) and urticaria (1). Patch testing showed positive reactions to carbamazepine in 7 patients; in addition. 2 patients had doubtful reactions. Positive patch test reactions were seen only in patients with exfoliative dermatitis (all 3 patients) and maculopapular exanthema (4 out of 7). None of the patients with fixed drug eruption, erythema multiforme or urticaria, or the control subjects, had positive patch test reactions 10 carbamazepine. The present study suggests that patch testing is useful in the diagnosis of carbamazepine allergy in patients with maculopapular eruptions or erythrodermas.     

Immunohistochemical characterization of cutaneous drug eruptions by STI571

BACKGROUND: STI571, a selective BCR-ABL tyrosine kinase inhibitor, is a promising new drug for chronic myelogenous leukemia (CML). However, the drug has been reported to be associated with adverse cutaneous drug eruptions with high frequency. OBJECTIVE: In this study, the characteristics of the cutaneous drug eruptions by STI571 were investigated. METHODS: The clinical records of 10 patients diagnosed with drug eruption by STI571 were reviewed. We obtained 10 skin biopsy specimens from patients with drug eruption by STI571, 6 from the antibiotics-induced drug eruption group, and 5 from normal skin (control). Immunohistochemical analysis was performed to detect CD4, CD8, CD56, IL-18, IL-1beta and ICAM-1 expression in the cutaneous drug eruption. RESULTS: Seven out of 10 patients had maculopapular exanthema, 2/10 erythema multiforme, 1/10 urticaria. We analyzed the composition of T-lymphocyte subsets from the infiltrates at the STI571-induced drug eruption site in eight patients. Unlike other drug eruptions, the increase in the CD8 expression was statistically significant, especially in the dermoepidermal junction and the upper dermis (P < 0.01). The enhanced expression of IL-18 and IL-1beta was observed as well. In contrast, ICAM-1 was either weakly positive or negative. CONCLUSION: Drug eruption caused by STI571 was mostly expressed as a maculopapular exanthema. The histopathological findings were similar in drug eruption by antibiotics or STI571. Unlike the drug eruptions caused by antibiotics, where the expression of CD4 was dominant, CD8 was dominant in drug eruptions by STI571. The expression of IL-18 and IL-1beta was increased in both groups. This elevation of IL-18 and IL-1beta may assist in understanding the pathogenesis of cutaneous drug eruption.     

P44A case of contact dermatitis caused by a NSAID''s soluble agent

Infliximab is a chimeric antitumor necrosis factor‐alpha monoclonal antibody used to treat Crohn's disease and rheumatoid arthritis. Acute infusion reactions, headache, fever, chills, urticaria and chest pain were seen in 17% of patients with infliximab compared with 7% of those receiving placebo. Other adverse cutaneous reactions are fungal dermatitis, eczema, seborrhoea, hordeolum, bullous eruption, furunculosis, periorbital oedema, hyperkeratosis, rosacea, verruca, skin pigmentation, alopecia, leukocytoclastic vasculitis, lichenoid drug eruption, erythema multiforme, perniosis‐like eruption, granuloma annulare and acute folliculitis. Any pathogenic mechanism has been suggested. Patch test with infliximab can induce flare‐up of lesions, nausea and malaise and suggest a percutaneous absortion. A sixty years‐old man with atopy background and rheumatoid arthritis treated with Remicare®, infliximab who developed a severe acute urticaria with angioedema is presented. The lesions appearance after previous endovenous administrations and the worsening spreading wheals days after the injection clinically suggested an hypersensitivity mechanism. The protocolized study drug hypersensitivity performed showed only the Prick Test positivity with infliximab at 30/60 minutes. Patch test with infliximab was negative and any adverse event was reported. Actually the patient is treated with etanercept and this drug is well tolerated. This result suggested a type I hypersensitivity mediated reaction. Urticaria could be induced as immunologic reaction of the host against the murine part of infliximab, just as it hapens with other antichimeric antibodies.     

药疹151例临床分析

目的探讨药疹患者的临床特点及防治策略。方法对本院2002年1月~2007年12月住院药疹患者的临床资料进行分析。结果常见致敏药物中前四位为抗生素类占31.8%,解热镇痛药占20.5%,中药及中成药占9.3%,抗癫痫药占6.6%。主要的药疹类型为多形红斑型(35.1%)、荨麻疹型(23.8%)、麻疹样/猩红热样型(19.9%)。重症药疹29例,主要由解热镇痛药及抗癫痫药引起,分别为8例和6例,均给予糖皮质激素治疗,1例自动出院,其余痊愈。结论引起药疹的主要致敏药物是抗生素类及解热镇痛药。药疹类型以多形红斑型、荨麻疹型及麻疹样/猩红热样型最常见。及早足量应用糖皮质激素是重症药疹治疗的关键。     

六年住院药疹患者回顾性分析

收集我院皮肤科2009年3月至2015年3月472例住院药疹患者资料进行回顾性分析,其中明确单一药物过敏者225例(47.67%),致敏药物中以抗生素类、解热镇痛类、抗癫痫类和中药为主。非重症药疹363例(76.91%),表现为发疹型145例,荨麻疹型39例,固定性药疹45例,多形红斑型51例;重症药疹109例(23.09%),其中Stevens-Johnson综合征53例,大疱性表皮坏死松解型16例,药物超敏综合征12例,红皮病型28例。95.76%药疹患者应用糖皮质激素治疗,非重症型与重症型药疹二组使用剂量有显著差异性,部分联合静脉注射用免疫球蛋白治疗。99.58%患者治愈,1例自动出院,1例死亡。     

Clinical study of cutaneous drug eruptions in 200 patients

Two hundred patients (112 males and 88 females) with cutaneous drug eruption were studied. The aim was to recognize the offending drug, to evaluate mortality and morbidity, educate the patient and avoid self-administration and readministration of drugs. Fixed drug eruption was the commonest reaction, seen in 61 patients; other reactions being urticaria and angioedema,morbilliform rash in 37, pruritus in 25, Stevens Johnson Syndrome (SJS) in 6, purpura in 6, exfoliative dermatitis in 5,photosensitivity in 5, toxic epidermal necrolysis in 2, acneiform eruption in 3, erythema multiforme in 2. Maximum patients belonged to the age group 41-50, followed by 21-30 and 31-40 years. The youngest was 1 year old and the oldest was 80 years old. Period of development of lesion after intake of drug varied from 1 day to 45 days. Cotrimoxazole was the commonest drug, in 26 cases; followed by Ibuprofen in 20 cases.     

柳氮磺胺吡啶致重症药疹1例

患者男,57岁。全身皮肤红斑、瘀斑伴瘙痒、发热10d。患者1个月前因"溃疡性结肠炎"口服"柳氮磺胺吡啶",20d后全身皮肤出现红斑、瘀斑伴瘙痒、发热。血常规检查示单核细胞及嗜酸性粒细胞增多,血小板减少;肝功能异常;胸部CT平扫示腋窝淋巴结肿大。结合病史、临床表现和辅助检查诊断为:重症药疹。予甲基泼尼松龙联合人免疫球蛋白等治疗痊愈。     

Skin manifestations of tularemia: a study of 88 cases in northern Finland during 16 years (1967-1983)

88 tularemia patients with secondary skin manifestations seen in northern Finland during 1967-1983 are described in this paper. Tularemia was ulceroglandular in 57% and pulmonary in 27% of the patients. 68% of the patients were women. The most common secondary skin manifestation was papular or vesicopapular eruption which was seen in 42% of the patients. Erythema nodosum either alone or in combination with some other skin eruption was encountered in 28% and erythema multiforme in 9% of the patients. Erythema nodosum was seen more often in patients with pulmonary tularemia than in other types of the disease (p less than 0.01). The clinical pictures of erythema nodosum and erythema multiforme caused by tularemia greatly resembled those caused by Yersinia. Tularemia should be remembered as one possible triggering factor of erythema nodosum and erythema multiforme.