大疱性表皮松解型药疹38例临床分析

为分析38例大疱性表皮松解型药疹的临床特征。回顾分析38例大疱性表皮松解型药疹患者的临床资料，重点比较儿童和成人患者的异同。解热镇痛药分别占儿童及成人患者致敏药物的59．1％和31．3％。该型药疹皮损虽重．似心脏损害轻。与成人比较，儿童多始发于面部，较少有口腔黏膜受累、发热及低蛋白血症，对糖皮质激素治疗反应好。解热镇痛药是大疱性表皮松解型药疹最常见的致敏药物。儿童较成人临床表现轻，治疗效果好。     

大疱性表皮松解坏死型药疹1例护理体会

大疱性表皮松解坏死型药疹１例护理体会俞华，董兰金，陈天明（指导者）福建省福清市医院（邮政编码３５０３００）患儿，男，１１岁。因口服ＡＰＣ致大疱性表皮松解坏死型药疹，皮损面积达９０％，伴呼吸道、消化道、泌尿系损害并继发肺炎。住院２３天痊愈出院，现将护理...     

药物反应

苯巴比妥致固定型药疹12例报告;头孢克洛胶囊致固定型药疹1例;普鲁卡因庆大霉素颗粒致大疱性表皮松解型药疹1例;复方丹参注射液致大疱性表皮松解型药疹1例;大剂量免疫球蛋白联合糖皮质激素治疗中毒性表皮坏死松解症疗效观察……[第一段]     

中毒性表皮坏死松解症12例临床分析

目的：探讨中毒性表皮坏死松解症(TEN)药疹的临床特点和治疗。方法：回顾性分析12例TEN药疹患者的临床特点和治疗。结果：TEN药疹患者潜伏期1～60天，平均18．7天。发热11／12例(91．7％)，肝损害10／12例(83．3％)，粘膜损害9／12例(75％)。经糖皮质激素治疗，加强护理，加强营养及预防感染，11例痊愈(91．7％)，1例死亡。结论：糖皮质激素治疗非常有效，强化护理、支持疗法及预防感染对降低死亡率非常重要。     

大疱性表皮松解型药疹34例回顾性分析

为探讨大疱性表皮松解型药疹的发病规律及诊治经验。回顾研究34例住院治疗的该型药疹患者。结果致敏药物以抗生素占首位，其次为解热镇痛药，抗癫痫类、抗痛风类、磺胺类药。30例皮损累及全身，伴有不同程度的黏膜损害。死亡7例．感染、脏器衰竭是主要死因。大疱性表皮松解型药疹的预后与及时停用过敏药物、年龄、皮损范围、糖皮质激素起用时间、感染及原发疾病的严重程度等因素有关.     

22例大疱性表皮松解型药疹患者的临床护理

我科2011年6月至2012年12月共收治22例大疱性表皮松解型药疹,现将临床护理进行回顾性分析,报道如下。 1临床资料 1．1一般资料 22例大疱性表皮松解型药疹患者中,男9例,女13例;年龄9～71岁;过敏药物：解热镇痛药6例,卡马西平5例,磺胺类药5例,头孢类药4例,化疗药物2例。所有患者尼氏征阳性,表皮松解、糜烂超过体表面积50％,其中4例超过90％,伴有不同程度口腔、眼结膜、呼吸道、胃肠道黏膜、外阴等处糜烂。合并肝功能损害3例,肾功能损害5例。     

重症药疹35例临床分析

目的：探讨重症药疹的临床特点及预后相关因素。方法：对临床收集35例重症药疹进行分析。结果：致敏药物以抗癫痫药为首位（占34．29％）；药疹类型以中毒性表皮坏死松解症（TEN）型最常见，各型药疹常伴系统损害；丙种球蛋白联合糖皮质激素治疗TEN型药疹疗效明显优于非丙种球蛋白治疗。结论：预后与药疹类型、基础疾病及治疗措施有很大关系，糖皮质激素治疗仍为首选，丙种球蛋白联合糖皮质激素治疗为重症药疹提供了更有效的方法。     

大疱性表皮坏死松解型药疹—43例回顾性研究

报告大疱性表皮坏死松解型药疹４３例。男２１例，女２２例，年龄２～８２岁。致病药物包括抗生素（头孢菌素、青霉素为主），解热镇痛药（安乃近为主），磺胺药（ＳＭＺｃｏ）及抗痛风药（别瞟呤醇）等。皮损累及全身者３６例（８３．７％），其中于２４小时内波及全身者１５例。３８例伴粘膜损害。病死１１例（２５．６％）。继发感染为主要死因。据分析，年龄、皮损范围、血尿素氮水平、皮质类固醇起用时间及继发感染等与本病预后有关。对本病的处理要点予以讨论。     

药物反应

重症药疹治疗疗效相关因素的多元分析，别嘌呤醇致重症药疹9例临床分析,儿童大疱性表皮坏死松解型药疹1例,住院药疹患者132例临床分析,口服非洛地平致剥脱性皮炎1例．     

重症药疹62例临床分析

目的:了解重症药疹的临床特征、治疗及预后.方法:回顾性分析笔者所在科室1998-2007年62例住院重症药疹患者的临床资料,其中大疱性表皮坏死松解型29例,重症多形红斑型22例,剥脱性皮炎型11例.在局部用药的同时,均早期应用大剂量糖皮质激素治疗[剂量相当于泼尼松1.0～2.5mg/(kg·d)].结果:62例患者中治愈51例,好转5例,死亡6例(均为大疱性表皮坏死松解犁患者).结论:对重症药疹患者应及早使用足量糖皮质激素,加强支持疗法,这是稳定病情、降低死亡率的关键.     

Bucillamine-induced toxic epidermal necrolysis and fixed drug eruption

We report two cases of bucillamine-induced bullous reactions with keratinocyte necrosis. The first patient, a 27-year-old woman, developed toxic epidermal necrolysis (TEN) over her whole body after taking bucillamine 300 mg/day for seven days. The second patient, a 63-year-old woman, developed several bullous erythemas on the mucous membranes and legs after taking bucillamine for more than two years. The fixed drug eruptions were diagnosed based on a provocation test in addition to clinical and histopathologic findings. These cases highlight the importance of considering fixed drug eruption as well as TEN in the differential diagnosis of bucillamine-induced bullous drug eruption.     

重症多形红斑与中毒性表皮坏死松解症患者的临床对比研究

目的探讨重症多形红斑(SJS)与中毒性表皮坏死松解症(TEN)的临床特点与临床治疗。方法对9例SJS和4例TEN住院患者的临床资料进行回顾性分析。结果 SJS组和TEN组患者中药物为最常见病因。TEN组的皮损范围、损害程度、粘膜病变均较SJS组更广泛、更严重。TEN患者主要表现为全身表皮松解,而SJS患者以靶形红斑为特征。TEN患者较SJS患者更易出现并发症。TEN患者病程急性期和恢复期时间均长于SJS患者。9例SJS和4例TEN患者早期均予以足量糖皮质激素治疗,TEN患者同时联用免疫球蛋白,13例患者均获痊愈。结论药物是SJS和TEN发病最主要的原因。TEN患者较SJS患者病变广泛且严重。药物诱发的SJS和TEN患者早期使用足量激素十分必要,TEN患者尚需静脉联用免疫球蛋白,提高抢救成功率。     

别嘌呤醇致重症药疹9例临床分析

目的探讨别嘌呤醇致重症药疹的临床特点。方法对9例别嘌呤醇致重症药疹患者的临床表现、实验室检查、治疗、预后进行回顾性分析。结果别嘌呤醇所致重症药疹包括重症多形红斑型、表皮坏死松解型、剥脱性皮炎型。潜伏期长、病情急重、肝肾受累常见、糖皮质激素治疗有效,但病程长、死亡率高。结论别嘌呤醇致重症药疹应用皮质类固醇激素治疗时宜早期、足量、足疗程、缓慢减量。     

Widespread Bullous Fixed Drug Eruption Mimicking Toxic Epidermal Necrolysis

This paper is written to heighten awareness of the presence of the most severe form of fixed drug eruption. Two patients with a widespread bullous form of fixed drug eruption (FDE) were initially given the diagnosis of toxic epidermal necrolysis (TEN). Both gave a history of a previous widespread eruption from the responsible drug, each had biopsies consistent with fixed drug eruption, and most importantly, both had an uncomplicated course, with complete cutaneous reepithelialization within 10 days. These observations suggest that widespread bullous fixed drug eruption may portend a more favorable prognosis than TEN, thus stressing the potential importance of distinguishing the two diseases. A review of fixed drug eruption and possible means of differentiating the widespread bullous form from TEN are discussed.     

Multifocal bullous fixed drug eruption mimicking Stevens-Johnson syndrome

The overlapping clinical features of fixed drug eruption (FDE), Stevens-Johnson syndrome (SJS) and toxic epidermal necrolysis (TEN) make differentiation between them difficult, especially if FDE is multifocal and extensive. We present a case of multifocal bullous FDE mimicking SJS.     

Severe bullous fixed drug eruption due to metronidazole mimicking a localized form of toxic epidermal necrolysis

A 55-year-old diabetic male who had severe bullous fixed drug eruption mimicking a localized form of toxic epidermal necrolysis 8 hours after taking metronidazole is presented.     

Patch testing in severe cutaneous adverse drug reactions, including Stevens-Johnson syndrome and toxic epidermal necrolysis

Patch testing may help to assess the culpability of a drug in an adverse reaction. Our aim was to study patch testing in severe cutaneous ad verse drug reactions [ADRs] (Stevens-Johnson syndromeitoxic epidermal necrolysis (SJS/TEN). acute genera exanthematous pustulosis (AGEP), and other cutaneous ADRs). 59 patients with cutaneous ADRs were included: 22 had SJS/TEN. 14 AGEP, and 23 other cutaneous ADRs. Patients were patch tested with the suspect drug and with H standard series of drugs. 2 patients among the 22 SJSTEN cases had a relevant positive test. 7 patients among the 14 AGEP cases had a relevant positive test. 6 patients among the 23 other cutaneous ADRs had a relevant positive test. Our results suggest that patch testing has a weak sensitivity in SJS'TEN and is not appropriate in these diseases. Patch testing seems more adapted to other cutaneous ADRs, such as AC it: P. in which the proportion of positive patch tests was significantly higher (P<0.02). Nevertheless, the difference of sensitivity of patch testing in SJS TEN, AGEP or other cutaneous ADRs could be linked not only to the clinical type of eruption, but also lo the different spectrum of culprit drugs in each type of eruption.     

Toxic epidermal necrolysis. Clinical findings and prognosis factors in 87 patients

Eighty-seven patients with toxic epidermal necrolysis were observed at H?pital Henri Mondor in Créteil, France, over the last 12 years. The mean percentage of body surface area involved was 39%. Erosive mucous membrane lesions, identical to those of Stevens-Johnson syndrome, were present in all but three cases. Necrolysis was sometimes generalized within 24 hours but usually spread progressively after a Stevens-Johnson syndrome-like aspect at the onset. Mortality was 25%. Infection, mainly with Staphylococus aureus and Pseudomonas aeruginosa, was the first cause of death, clearly responsible in ten of 20 cases. Age, extension of necrolysis, idiopathic nature of toxic epidermal necrolysis, ingestion of many drugs, elevation of urea, creatinine, and glucose levels, neutropenia, lymphopenia, and thrombocytopenia were statistically linked to a bad prognosis. A multivariant analysis showed that three of these prognosis factors are of paramount importance, namely: age, area of necrolysis, and serum urea level. Pigmentary changes and sicca syndrome were frequently observed sequelae in survivors.     

Staphylococcal scalded skin syndrome in an adult with Hodgkin's disease.

An elderly man with Hodgkin's disease who was receiving multiple drug chemotherapy became septic and a wide spread bullous eruption developed. Intraepidermal cleavage on skin biopsy supported a diagnosis of the staphylococcal scalded skin syndrome (SSSS) type of toxic epidermal necrolysis. Blood cultures confirmed a staphylococcal septicemia. Occurrence of this syndrome in an adult is unusual. A review of the literature on SSSS indicates an increased mortality when adults are compared with children with this syndrome.