777例药疹临床分析

目的:探讨药疹的致敏药物、临床表现及特点,以期提高用药安全性。方法:对华中科技大学同济医学院附属同济医院1988年~2015年(共27年)的777例住院药疹患者的临床资料进行回顾性分析。结果:777患者中503例(64.73%)可明确致敏药物。在这些患者中,由抗生素所致者占74.75%(376/503);由抗癫痫药所致者占11.33%(57/503);由解热镇痛药所致者占8.15%(41/503)。最常见的药疹类型为发疹型,占65.46%(509/777),其次为多形红斑型、固定型和荨麻疹型,分别占11.34%(88/777)、9.66%(75/777)和8.12%(63/777)。对27年来致敏药物的分布分析发现:头孢菌素类、喹诺酮类及中药所占比例逐年上升。抗生素及解热镇痛药引起药疹的潜伏期多在1周以内,抗癫痫药和抗痛风药引起药疹的潜伏期多在1周以上。重症药疹共有32例,其中由抗癫痫药引起的有18例,由抗痛风药引起的有5例。重症药疹常伴发热及内脏损害。结论:在这些药疹患者中,常见的致敏药物为抗生素、抗癫痫药、解热镇痛药。头孢菌素类、喹诺酮类及中药所致药疹比率在近年来上升明显,应引起重视。     

303例药疹临床分析

目的:明确我院303例药疹患者的致敏药物。方法 对2006年9月至2016年8月间303例药疹患者的临床资料进行回顾性分析。结果：303例药疹患者中，重症药疹34例，轻中度药疹269例，其中188例患者为发疹型药疹。183例轻中度药疹患者可明确致敏药物，主要致敏药物为抗生素144例，解热镇痛药致敏22例。31例重症药疹患者可明确致敏药物，主要致敏药物为抗癫痫药物11例，抗痛风药物8例，抗生素7例。结论：本院轻中度药疹患者中抗生素类为最常见的致敏药物，重症药疹中抗癫痫药为最常见的致敏药物。     

303例药疹临床研究

目的:明确我院303例药疹患者的致敏药物。方法:对2006年9月至2016年8月间303例药疹患者的临床资料进行回顾性分析。结果:303例药疹患者中,重症药疹34例,轻中度药疹269例,其中188例患者为发疹型药疹。183例轻中度药疹患者可明确致敏药物,主要致敏药物为抗生素144例,解热镇痛药致敏22例。31例重症药疹患者可明确致敏药物,主要致敏药物为抗癫痫药物11例,抗痛风药物8例,抗生素7例。结论:本院轻中度药疹患者中抗生素类为最常见的致敏药物,重症药疹中抗癫痫药为最常见的致敏药物。     

428例药疹临床分析

目的：了解药疹的主要临床特征及常见的致敏药物。方法：收集1998年10月～2003年10月确诊为药疹的病例428例，并对其发病年龄、主要致敏药物、皮疹类型等临床特征进行分析。结果：药疹的发病年龄有所提高，主要致敏药物以抗生素最常见，其次为解热镇痛抗炎药、生物制品、抗痛风药、抗癫痫药及中成药等。皮疹类型以麻疹样或猩红热样型最常见，其次为荨麻疹型、固定型、多形红斑型等，抗痛风药和抗癫痫病药多引起重症药疹。结论：引起药疹的主要致敏药物的种类已发生变化，抗生素已上升为药疹致病药物中的首位。     

重症药疹74例临床分析

目的分析引起重症药疹的致敏药物类型及治疗方案。方法回顾性分析2002年-2006年74例重症药疹住院病人诊疗情况。结果抗痛风类药所致药疹为第一位，其次为抗癫痫类药物及抗生素类。结论抗痛风类药所致重症药疹在临床上比例增高。治疗应早期、足量、短程使用糖皮质激素．，并控制并发症的发生。     

重症药疹55例临床分析

目的探讨重症药疹的致敏药物、发生规律、临床特征和治疗措施。方法对2011年1月-2016年1月本院收治的55例重症药疹患者的临床资料进行回顾性分析。结果 55例重症药疹患者中,男女比例为7∶4,以重症多形红斑型药疹最为多见(26,47.27%),单种致敏药物以抗生素及抗癫痫药为首位,各9例(16.36%),抗癫痫药以卡马西平最常见,共8例(14.55%),抗生素类药物以头孢、青霉素类多见6例(11.32%)。多种抗生素联用9例(16.36%),抗生素联合解热镇痛药有6例(11.32%),抗生素联合抗癫痫药1例(1.82%),镇静类药1例(1.82%)。黏膜损害34例(61.81%),肝功能损害31例(56.36%)。均予系统用糖皮质激素治疗,其中7例(12.73%)联合人免疫球蛋白治疗。结论重症药疹中以重症多形红斑型药疹居多,抗生素类药物及抗癫痫药是引起重症药疹最常见的药物,多种药物联合应用比例偏高。重症药疹常出现黏膜损伤和肝功能损伤。系统应用糖皮质激素尤其是联合人免疫球蛋白治疗重症药疹有效。     

52例重症药疹患者临床分析

 目的:探讨重症药疹的临床特征，分析常见致敏药、治疗方案及转归。方法：回顾性分析我科自2013年1月-2018年12月住院治疗的重症药疹患者临床资料。结果：52例重症药疹中：重症多形红斑型39例，中毒性表皮坏死松解型6例，红皮病型3例，药物超敏反应综合征4例。致敏药物主要是解热镇痛药、抗癫痫药、抗生素类及别嘌呤醇。33例患者使用糖皮质激素治疗，其余使用单独激素冲击或人免疫球蛋白（IVIG）冲击或激素联合IVIG冲击疗法，所有患者均临床治愈。结论：重症药疹患者应早期足量使用激素治疗，必要时可联合IVIG治疗，尽量减少抗生素的使用，避免交叉过敏，同时加强支持疗法及护理，可极大减少死亡率。     

109例住院药疹患者临床分析

目的分析药疹患者的临床特点,为临床合理用药及药疹的诊治提供参考。方法回顾性分析109例药疹患者的临床资料,总结药疹的疹型、致敏药物、临床表现、实验室检查及治疗与转归情况。结果重症药疹患者29例,其中重症多形红斑型药疹21例,大疱性表皮松解坏死型药疹8例;非重症患者80例,其中发疹型药疹39例,固定型药疹15例,多形红斑型药疹13例,多形态型药疹13例。重症患者与非重症患者在合并发热、血常规、尿常规、肝功能、肾功能异常、嗜酸性粒细胞增高及黏膜受累等各方面差异均有统计学意义(P0.05)。109例患者中88例有明确的单一的致敏药物,主要致敏药物依次为解热镇痛药、抗生素、抗癫痫药类、磺胺类及中药等。结论药疹皮疹形态多样,部分患者皮损及症状相对较重,并可累及内脏系统,严重者可危及生命,应及早积极治疗。     

重症药疹73例临床分析

目的:分析重症药疹的致敏药物及临床特点。方法:回顾性分析我科的73例重症药疹患者的临床资料。结果:73例重症药疹中66例(90.41%)可确定致敏药物,其中抗癫痫药24例(32.88%)、抗痛风药18例(24.66%)、抗菌药12例(16.44%)和解热镇痛药7例(9.59%),占所有致敏药物的83.57%;单一致敏药物中,卡马西平(12.33%)和别嘌醇(24.66%)导致的重症药疹最为多见;重症多形红斑型药疹29例(39.73%);糖皮质激素治疗重症药疹的总有效率为93.15%。结论:重症药疹最常见的致敏药物为抗癫痫药、抗痛风药、抗菌药和解热镇痛药,重症多形红斑型最常见,治疗首选糖皮质激素。     

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。     

Causative drugs for drug-induced cutaneous reactions in central China: a 608-case analysis

BackgroundReports regarding the causative drugs of drug-induced cutaneous adverse reactions in China are indistinct, such that different regions have reported the spectrum of drugs differs substantially in different clinical conditions.ObjectiveTo explore the causative drugs that led to cutaneous reactions.MethodsAdverse drug reaction reports from central China were collected and divided into cutaneous adverse reactions and severe cutaneous adverse reactions groups. Cases were reviewed retrospectively for causative drugs.ResultsThe male:female ratio was equal in both cutaneous adverse reactions and severe cutaneous adverse reactions. In cutaneous adverse reactions (n = 482), the highest incidence happened between 51 and 60 years of age and the top three causative drugs were antibiotics (48%), Chinese medicine (16%), and allopurinol (9%). In severe cutaneous adverse reactions (n = 126), the highest incidence happened between 41 and 50 years of age and the top three causative drugs were sedative-hypnotics and antiepileptics (39%), antibiotics (22%), and allopurinol (15%). Carbamazepine was the most frequently used single-drug (16/18) in sedative-hypnotics and antiepileptics. β-lactams were the most frequently used antibiotics that induced both cutaneous adverse reactions and severe cutaneous adverse reactions.Study limitationsThe small sample size, retrospective design, collection of cutaneous adverse reactions and severe cutaneous adverse reactions at different time frames and locations, and exclusion of patients taking more than five medications are limitations of the study.ConclusionsGender does not affect cutaneous adverse reactions and severe cutaneous adverse reactions. The top three drugs to induce cutaneous adverse reactions are antibiotics, Chinese medicine, and allopurinol, while those that triggered severe cutaneous adverse reactions are sedative-hypnotics and antiepileptics, antibiotics, and allopurinol. Carbamazepine is the most frequent single drug that induces severe cutaneous adverse reactions. β-lactams are the most frequently used antibiotics that induce both cutaneous adverse reactions and severe cutaneous adverse reactions.     

住院药疹239例致敏药物分析

目的:明确239例药疹的主要致敏药物种类。方法:对本院皮肤科2007年5月至2017年4月就诊的239例药疹患者临床资料进行回顾性分析。结果:239例药疹患者中可确定致敏药物有105例(非重症药疹患者88例,重症药疹患者17例)。非重症药疹致敏药物主要为抗生素类32例(36.4%),解热镇痛药17例(19.3%)、中药16例(18.2%)。重症药疹主要致敏药物为抗生素类5例(29.4%),解热镇痛药3例(17.6%)、卡马西平类3例(17.6%)、抗痛风类药物3例(17.6%)。结论:本组患者药疹最常见的致敏药物为抗生素类。     

Drug eruptions in Bangkok: a 1-year study at Ramathibodi Hospital

Background As new drugs are introduced onto the market, it is important to determine those that can cause cutaneous reactions and with what frequency. In addition, drugs that have been used for a long period of time may cause new types of eruption that have not been observed previously. The purpose of this study was to evaluate the types of drug eruption and the causative agents in a hospital-based population for a period of 1 year. Methods All in- and outpatients consulting for drug eruptions at the Dermatology Clinic, Ramathibodi Hospital from June 1995 to May 1996 were included in the study. The history and physical examination were performed by one of the authors. In suspected cases, a skin biopsy was carried out to confirm the diagnosis. Rechallenge tests with suspected drugs were performed with informed consent. Results One hundred and thirty-two patients were enrolled in the study. The most common types of drug eruption were maculopapular eruption, fixed drug eruption, and urticaria. Antimicrobial agents were found to be the most common causative drugs, followed by antipyretic/anti-inflammatory agents and drugs acting on the central nervous system. Conclusions Although the most common type of drug eruption and the most common causative agents were not different from those found in previous studies, the new generation of antibiotics and antifungal agents were found to be a frequent cause of drug eruptions. New types of drug eruption, such as generalized exanthematous pustulosis and acral erythema, were observed in this study.     

Drug Eruptions: An 8-year Study Including 106 Inpatients at a Dermatology Clinic in Turkey

Background:

Few clinical studies are found in the literature about patients hospitalized with a diagnosis of cutaneous drug eruption.

Aims:

To determine the clinical types of drug eruptions and their causative agents in a hospital-based population.

Materials and Methods:

This retrospective study was performed in the Dermatology Department of Haseki General Hospital. Through 1751 patients hospitalized in this department between 2002 and 2009, inpatients diagnosed as drug eruption were evaluated according to WHO causality definitions. 106 patients composed of probable and possible cases of cutaneous drug eruptions were included in this study.

Results:

Seventy one females and 35 males were evolved. Mean age was 44.03±15.14. Duration between drug intake and onset of reaction varied from 5 minutes to 3 months. The most common clinical type was urticaria and/or angioedema in 48.1% of the patients, followed by maculopapular rash in 13.2%, and drug rash with eosinophilia and systemic symptoms in 8.5%. Drugs most frequently associated with cutaneous drug eruptions were antimicrobial agents in 40.5% of the patients, followed by antipyretic/anti-inflammatory analgesics in 31.1%, and antiepileptics in 11.3%.

Conclusion:

Urticaria and/or angioedema and maculopapular rash comprised majority of the drug eruptions. Rare reactions such as acute generalized exanthematous pustulosis, sweet syndrome, oral ulceration were also found. Antimicrobial agents and antipyretic/anti-inflammatory analgesics were the most commonly implicated drugs. Infrequently reported adverse reactions to myorelaxant agents, newer cephalosporins and fluoroquinolones were also detected. We suppose that studies on drug eruptions should continue, because the pattern of consumption of drugs is changing in every country at different periods and many new drugs are introduced on the market continuously.     

Cutaneous adverse drug reactions seen in a tertiary hospital in Johor,Malaysia

Background Adverse drug reactions are most commonly cutaneous in nature. Patterns of cutaneous adverse drug reactions (ADRs) and their causative drugs vary among the different populations previously studied. Objective Our aim is to determine the clinical pattern of drug eruptions and the common drugs implicated, particularly in severe cutaneous ADRs in our population. Materials and Methods This study was done by analyzing the database established for all adverse cutaneous drug reactions seen from January 2001 until December 2008. Results A total of 281 cutaneous ADRs were seen in 280 patients. The most common reaction pattern was maculopapular eruption (111 cases, 39.5%) followed by Stevens‐Johnson Syndrome (SJS: 79 cases, 28.1%), drug reaction with eosinophilia and systemic symptoms (DRESS: 19 cases, 6.8%), toxic epidermal necrolysis (TEN: 16 cases, 5.7 %), urticaria/angioedema (15 cases, 5.3%) and fixed drug eruptions (15 cases, 5.3%). Antibiotics (38.8%) and anticonvulsants (23.8%) accounted for 62.6% of the 281 cutaneous ADRs seen. Allopurinol was implicated in 39 (13.9%), carbamazepine in 29 (10.3%), phenytoin in 27 (9.6%) and cotrimoxazole in 26 (9.3%) cases. Carbamazepine, allopurinol and cotrimoxazole were the three main causative drugs of SJS/TEN accounting for 24.0%, 18.8% and 12.5% respectively of the 96 cases seen whereas DRESS was mainly caused by allopurinol (10 cases, 52.6%) and phenytoin (3 cases, 15.8%). Discussion The reaction patterns and drugs causing cutaneous ADRs in our population are similar to those seen in other countries although we have a much higher proportion of severe cutaneous ADRs probably due to referral bias, different prescribing habit and a higher prevalence of HLA‐B*1502 and HLA‐B*5801 which are genetic markers for carbamazepine‐induced SJS/TEN and allopurinol‐induced SJS/TEN/DRESS respectively. Conclusion The most common reaction pattern seen in our study population was maculopapular eruptions. Antibiotics, anticonvulsants and NSAIDs were the most frequently implicated drug groups. Carbamazepine and allopurinol were the two main causative drugs of severe ADRs in our population.     

138例药疹住院病例分析

目的 探讨药疹致敏药物与临床表现。方法 收集2005年1月至2007年6月，对住院治疗的138例药疹病例，进行回顾性分析。结果 主要的致敏药物为抗菌药，占31.46%；其中阿莫西林致病最常见，占11.23%；其次为非甾体抗炎药，占28.09%；中药类，占15.73%。口服给药是引起药疹的主要途径，占54.17%。主要的皮疹类型为多形红斑型，占33.71％，其次为固定型，占28.09％，发疹型占22.47％。重症药疹主要致敏药物为抗痛风药和中药类。结论 抗菌药和非甾体抗炎药引起药疹比较常见，尤其是阿莫西林。中成药引起药疹的发生率有所上升，临床应重视口服给药引起药疹的问题。     

Patch testing in fixed drug eruptions--a 20-year review

Background. The fixed drug eruption is a common adverse drug reaction. Clear identification of the culprit drug is not always possible in the clinical setting, and oral rechallenge may induce new lesions or severe reactions. Objectives. The main purpose of this study was to evaluate the diagnostic value of patch testing in establishing an aetiological diagnosis in fixed drug eruptions. Method. A retrospective analysis was conducted evaluating 52 patients (17M/35F, mean age 53±17 years) with clinical diagnoses of fixed drug eruptions submitted to patch tests in a 20‐year period in a Dermatology Department. Nonsteroidal anti‐inflammatory drugs (NSAID) were clinically suspected in 90.4% of the cases, followed by antibiotics (28.9%) and paracetamol (15.4%). Results. Patch tests on pigmented lesions were reactive in 21 patients (40.4%), 20 of those to NSAID (nimesulide, piroxicam and etoricoxib) and 1 to an antihistamine (cetirizine). All patch tests using other drugs were negative, even under conditions of high clinical suspicion. Oral rechallenge allowed confirmation of drug imputability in 5 of 31 test‐negative cases. Cross reactivity was frequently observed between piroxicam and other oxicams, and between different antihistamines. Conclusions. Patch testing was shown to be a simple and safe method to confirm drug imputabililty in fixed drug eruption, mainly when NSAID or multiple drugs are suspected. Persistent lack of reactivity to drug classes such as antibiotics and allopurinol represent an important limitation.     

Clinical Pattern of Cutaneous Drug Eruption among Children and Adolescents in

Abstract: Various types of cutaneous drug eruptions and the Incriminating drugs were analyzed tn 50 children and adolescents up to 18 years of age (34 or 65% boys, 16 or 32% girls). Thirteen (26%) patients had a maculopapular rash, 11 (22%) a fixed drug eruption (FDE), 10 erythema multiforme (EM), 6 (12%) toxic epidermal necrolysis (TEN), 5 (10%) Stevens-Johnson syndrome (SJS), 3 (6%) urticaria, and 2 (4%) erythroderma. The Incubation period for maculopapular rashes, SJS and TEN due to commonly used antibiotics and sulfonamides was short, a few hours to two to three days, reflecting reexposure, and for drugs used sparingly such as antiepileptics and antitubereulosis agents, was approximately one week or more, suggesting a first exposure. Antibiotics were responsible for cutaneous eruptions in 27 patients, followed by antlepileptics In 17, analgin in 4, and metronidazole and albendazole in 1 each. Cotrimoxazole, a combination of sulfamethoxazole and trimethoprim, was the most common antibacterial responsible for eruptions (11 patients), followed by penicillin and its semisynthetlc derivatives (8 patients), sulfonamide alone (3 patients), and other antibiotics (4 patients). Antiepileptics were the most frequently incriminated drugs in EM, TEN, and SJS. The role of systemic corticosteroids in the management of SJS and TEN is controversial. We administered prednisolone or an equivalent corticosteroid 2 mg/kg/day for 7 to 14 days. With this dosage the mortality rate in the combined patients with TEN and SJS was 18.2%. Our limited experience suggests that these drugs might still have a role in the management of SJS and TEN In children and adolescents.     

Drug eruptions (a series of 148 cases)

A total number of 148 patients, comprising of 101 males and 47 females diagnosed as drug eruptions were reviewed. The youngest patient was eight and the oldest 73 years. The mean age was 34 years. 75(50.7%) patients were in the age group of 20 to 40 years. In 88(59.5%) pruritus was the chief associated symptom. 116(78.4%) developed eruptions within 2 weeks. 29(19.6%) had single site involvement, 92(62.2%) had lesions at more than one site and 25(16.9%) patients had generalised skin and mucous membrane involvement. The commonest skin reactions were fixed drug eruptions in 39(26.4%) cases. Almost all types of drug eruptions were observed. The eruptions were caused by 37 different drugs, the commonest being sulphonamides in 28(18.9%) cases. Systemic side effects were recorded in 13(8.8%) patients. 76(51.4%) were treated with topical medicaments. Out of the remaining, 33(22.3%) were managed by antihistamines and 26(17.6%) by steroids in addition to topical therapy. No treatment was required in 13(8.8%). 117(79.1%) were treated as out patients and 31(20.9%) were hospitalised. One (0.7%) patient died of toxic epidermal necrolysis due to penicillamine.