drugeruption藥物疹-wenkub
2023-04-07 00:04:04 本頁面
【正文】 disease spectrum. ? Erythema multiforme SJS TEN Erythema multiforme “target” or “iris” lesion SJS/TEN ?Causes: –Most mon: sulfamethoxazole(13/100,000), sulfadoxine with pyrimethamine (10/100,000), carbamazepine(14/100,000). –Antibiotics (especially longacting sulfa drugs and penicillins). –Other: anticonvulsants, antiinflammatory and allopurinol are also causes. ?Mechanism: unknown Presentation: ?spread rapidly (within 4 days) to their maximum extent ?Initial lesions: macular, iris lesions and bullae followed by desquamation, then slough. ?mucosal surfaces: difficult swallowing(GI), painful urination, photophobia, respiratory and alimentary tract involvement. Workup: ?Skin bx ?DDX: Paraneoplastic pemphigus (excluded with DIF). Graftversus host disease (hx) and SSSS ( superficial blister). Management ?Similar to an extensive burn Fluid and electrolyte imbalances, bacteremia from loss of protective skin barrier, hypercatabolism, and sometimes ARDS ?IVIG in 10 pts in doses up to g/kg/day for 4 days led to response in 48 hrs and skin healing within 1 week No adverse rxn’s where observed ? Previous general experience with the drugs ? Latent periods: The rash begins 5 to 10 days (range, 1 day to 4 weeks) after beginning the drug and may occur after the drug is terminated. ? Clinical manifestation ? Skin testing (penicillin, vaccine et al.) Diagnosis Management ?Discontinue the offending agent ?Administer appropriate treatment Glucocorticoids: as early as possible, full dose, Antibiotics: ?Provide supportive or palliative care ., hydration, warm / cold presses, analgesics or antipruritics ?Topical treatment Prevention ?Avoid inappropriate drugs in the context of clinical condition ?Use right dose, route, frequency based on patient variables ?Elicit medicati
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