中毒性表皮坏死松解症1例

<正>患者男,45岁,因全身红斑、水疱伴发热4 d,于2019年10月30日收入我科治疗。患者4 d前因感冒及痛风于外院予抗生素及抗痛风药治疗后（具体药物及用法用量不详）,躯干和四肢出现数个约3 cm×2 cm靶形红斑,伴瘙痒,未诊治。此后症状持续加重,2 d前于外院住院治疗,     

中毒性表皮坏死松解症

中毒性表皮坏死松解症(TEN)是一种累及皮肤和粘膜、危及生命的急性综合征。及时、正确的诊断和处理,是防止死亡,避免并发症,促进恢复的关键。现就此病在病原学、临床表现、组织学特征、发病机理、鉴别诊断、治疗处理及预后方面的近期研究进展作一扼要综述,以供临床工作参考。     

小儿中毒性表皮坏死松解症15例临床分析

本文对１５例小儿中毒性表皮坏死松解症（ＴＥＮ）进行回顾性分析。男性７例,女性８例,剥脱面积占体表面各４５％￣９８％不等。１５例患者均有用药史,致敏药物以镇静抗癫痫药物为首,死亡１例,后遗症５例。归纳总结出小儿ＴＥＮ的诊断标准。关于皮腩类固醇激素在治疗ＴＥＮ中的应用,我们认为早期短期应用是必要的,主意纠正水、盐、电解质平衡的紊乱,营养的供应和皮肤粘膜的护理。     

中毒性表皮坏死松解症研究进展

中毒性表皮坏死松解症是一种严重威胁生命的疾病，常由药物诱发，现已经证实角质形成细胞凋亡是其最突出的组织学表现，由FasL-Fas介导的细胞免疫反应在中毒性表皮坏死松解症中起到了重要的作用。静脉注射用丙种球蛋白对该病有明显的治疗效果。     

花红片致中毒性表皮坏死松解症1例

患者女,29岁.因全身红斑、水疱及糜烂伴痒痛5d于2011年5月12日入院.患者入院前2周因"妇科病"自行口服某药业所生产花红片(主要成分白花蛇舌草、鸡血藤、菥蓂等)每日3次,每次3片.入院前5d,患者全身出现散在红斑、水疱,伴痒痛感,口腔、外阴黏膜出现糜烂、溃疡,发热38.5℃.于当地医院连续3d口服泼尼松30 mg/d治疗未见好转.     

中毒性表皮坏死松解症的发病机理

随着免疫学技术的发展,人们对中毒性表皮坏死松解症的发病机理有了深入的认识。其发病与致敏药物代谢异常、遗传易感因素、细胞免疫介导及细胞因子的作用密切相关。本文就其发病机理的研究进展进行综述。     

大剂量丙种球蛋白冲击治疗中毒性表皮坏死松解症1例

患儿女，5岁。因“发热5d伴皮疹3d”于2003年1月16日入院。入院前5d，患儿因发热肌内注射“安痛定”。入院前3d，第2次肌内注射“安痛定”后，面部出现黄豆大红色斑点，瘙痒。入院前2d，皮疹播散至全身，体温波动在39～40℃。此后红色斑点逐渐变大、融合，遂来我院求治。体格检查：体温40℃，心率160次／min，呼吸30次／min，血压14．7／9．33kPa(110／70mmHg)，双     

新生儿中毒性表皮坏死松解症1例的护理体会

新生儿中毒性表皮坏死松解症１例的护理体会江耀陆王俐黄少薇李佳玫（汕大医学院附一院５１５０４１）中毒性表皮坏死松解症是一种严重的皮肤病，如病情重笃或处理不当可导致死亡。新生儿缺乏自理能力，机体抵抗力差，再加上表皮剥脱，机体缺乏了一层重要的防护与屏障层，...     

小儿中毒性表皮松解症2例报告

小儿中毒性表皮松解症２例报告宋继传，冯谊，宋琴（湖北医科大学附属第二医院皮肤科４３００７１）我科１９９５年收治金葡菌型和非金葡菌型患儿各１例，现报告如下：例１：患儿，女，５岁，全身起疱疹３天，伴发烧１天来我院急诊以ＳＳＳＳ收住院。检查：体温３８．４℃...     

Toxic epidermal necrolysis and Stevens-Johnson syndrome after COVID-19 infection and vaccination

Stevens-Johnson Syndrome (SJS) is a rare but severe skin reaction characterized by blistering and peeling of the skin and ulcerations of mucous membranes; toxic epidermal necrolysis (TEN) is a subset of SJS characterized by the involvement of >30% of the skin. Though previously associated with drugs and infections, discussions on the association between TEN/SJS and COVID-19 have been limited. We present a review of TEN/SJS after COVID-19 infection and vaccination. Literature searches were conducted on PubMed and Google Scholar from 2019 to 8/2022. Thirty-eight articles were selected based on subject relevance, and references within selected articles were also screened for relevance. As of 8/2022, there have been 34 published cases of TEN, SJS, and SJS-TEN overlap after COVID-19 infection and vaccination, including 12 cases after vaccination and 22 cases after infection. Multiple authors hypothesize that virotopes or excipients in COVID-19 vaccines can activate T-cells or cytokines to induce TEN/SJS. Meanwhile, some hypothesize that COVID-19 infection induces immune activation that can trigger TEN/SJS or increase susceptibility to drug-induced TEN/SJS. Treatments for post-infection and post-vaccination TEN/SJS vary significantly. We recommend remaining vigilant for this rare and severe potential complication.     

中毒性表皮坏死松解型药疹

报告1例中毒性表皮坏死松解型药疹(TEN).患者男,62岁.心脏冠状动脉支架术后出现全身红斑7 d,脱屑3 d.围术期曾使用过多种药物.全身表皮剥脱面积>30%体表面积,伴有黏膜损害.停用其他药物,继续给予患者氯吡格雷抗血小板治疗,同时使用大剂量糖皮质激素和静脉注射用人免疫球蛋白后获得治愈.     

Toxic epidermal necrolysis following morbilli-parotitis-rubella vaccination

We present the first reported case of toxic epidermal necrolysis (TEN) caused by morbilli-parotitis-rubella (MPR) vaccine. A 13-year-old girl developed TEN 7 days after she received live, attenuated, triple MPR vaccine. The history of drug intake and any illness was negative. At admission the patient was acutely ill with high fever. The whole body was erythematous. The epidermis was wrinkled and the Nikolsky sign was positive. Numerous erosions were present on the lips and genital region. On the seventh day of illness, the eruption involved 80% of the skin. Systemic corticosteroid therapy was not employed. The skin and mucosal defects completely epithelized by the end of the third week of illness. Mild keratoconjunctivitis sicca remained because of permanent cup cell damage.     

Toxic epidermal necrolysis successfully treated with etanercept

Toxic epidermal necrolysis (TEN) is a rare and acute severe adverse reaction to drugs, characterised by massive apoptosis and widespread epidermal and mucosal detachment. Although no gold standard therapy exists, human i.v. immunoglobulins have recently been described as an effective treatment for this disease. We report a case of phenobarbital-induced TEN in a 59-year-old white woman where the epidermal detachment stopped 48 h after beginning the etanercept treatment with complete healing after 20 days. To the best of our knowledge, this is only the second reported case of TEN successfully treated with etanercept.     

新冠疫苗接种后罹患成人Blaschko皮炎一例

患者,女,30岁。右腹部及右下肢多发丘疹45天。结合临床和病理特点诊断为成人Blaschko皮炎。患者发病前曾注射新冠疫苗(发病前30天注射第一针、发病前15天注射第二针)。     

中毒性表皮坏死松解症的研究进展

中毒性表皮坏死松解症是一种以表皮剥脱坏死为主要表现的药源性疾病,伴有表皮、黏膜以及肝肾功能的损害,死亡率高.其发病机制尚不完全清楚,遗传易感性、特定的T细胞抗原受体序列、药物特异性T细胞、细胞毒蛋白均在其中起着重要作用.治疗的主要方法包括一般处理、血浆置换、糖皮质激素、免疫球蛋白、肿瘤坏死因子α抑制剂等,尤其糖皮质激素和肿瘤坏死因子α抑制剂的疗效近年来得到较多肯定.     

Toxic epidermal necrolysis caused by over the counter eyedrops

We present a case of a 15‐year‐old boy who developed toxic epidermal necrolysis (TEN) from sulfacetamide eyedrops. He presented with conjunctival injection and an erythematous rash that rapidly progressed to epidermal necrosis of over 30% of his body. A skin biopsy revealed an acute lichenoid reaction pattern consistent with TEN. After 22 days in hospital, he was left with significant scarring to his eyes, mouth and anogenital areas. An extensive search for an infective aetiology was negative. Previously exposed to bactrim tablets, he used Bleph‐10 eyedrops 3 days before admission to hospital. The patient had a strong family history of sulphur allergy. The onset of TEN after topical administration of medication has been reported rarely in the literature. This case highlights the need for a thorough medication history that includes topical preparations.     

A case of eruptive lichen spinulosus after toxic epidermal necrolysis

We report a case of a 13-year-old boy who presented with eruptive monomorphic white papules on the trunk and arms involving regions previously affected by toxic epidermal necrolysis (TEN). Biopsy revealed compact keratin involving the hair follicle and sparse mixed perivascular infiltrate, findings consistent with lichen spinulosus. Improvement was noted after treatment with ammonium lactate 12% lotion. While cutaneous dyschromia and xerosis are common after TEN, lichen spinulosus has not yet been described in the literature. It is important for providers to be aware of any potential cutaneous sequelae of TEN that can affect quality of life in order to best counsel their patients.