D rug Eruption

1. Drug Eruption

2. Definition Drug eruption :various kinds of drugs delivered into human body by kinds of means create the cutaneous and mucosal reaction.

3. Drugs delivered by kinds of means • Oral • Injections (subcutaneous\intramuscularly\intravenous) • External use ( eye drops、nasal drops) • Inhalation • Buccal • Gargle • Embolism( anus suppository、pessary) • Coloclysis

4. Medicines causing the drug reaction • 80’s~90’s • Antibiotic • Antipodagrics • Nonsteroidal antiinflammatatoyr agents • Sulfa-drugs 50’s~60’s Sulfa-drugs Antipyretic analgesic Antibiotic Hypnotics

5. Pathogensis Skin testing is negtive, why does the drug still cause the reaction? The drug was discontinued a week ago, why do the eruptions appear now? Penicilin did not cause reactions before, why am I allergic to it now ？ Why?

6. No reaction readministration A new drug Normal human No eruption Severe eruption n hypersensitivity within24h 4~20days later eruption

7. Pathogenesis Hypersensitiveness human Special allergic reaction ?? drug Antigenicity

8. Characteristic of allergic reaction • Has a certain incubation period • Associated with humoral or cell-mediated immune • Readministration, eruption recur • Cross-reaction • Skin sensitivity test is positive • Indurate or desensitize • Steroid and antihistamine are effective

9. Incubation period：from the day of contacting antigen to that of eruption appearing • First exposure to the medication : eruptions appear an average of 7~9d (3~20days) after the drug is started • Readministration，eruptions appear an average10h( few minutes -24h) after the drug is started

10. Clinical manifestation Incubation period The onset and evolution of the eruptions Clinical morphology Course Different clinical types Depended on

11. Two typical drug eruptions Vulgary • （一） • （二） Exfoliative dermatitis

12. Clinical feature of vulgary drug eruption • Incubation period：4~20days • An acute onset of the disease • Eruptions spread from face to trunk, extremities, and are symmetrical, general • Courses are 2~4 weeks, eruptions may clear if the medicine discontinues

13. Clinical morphology of vulgary drug eruption • Fixed eyrthema • Toxic epidermal necrolysis • Scarlatiniform eyrthema • Morbilliform erythema • Erythema multiform • Urticaria • Pityriasis rose • Purpuric

14. Clinical feature of fixed erythema • Fixed • One or several，if recur ,eruption may be increased, enlarged • Favorite site at oral, genital mucosa • Eruptions are round or elliptic prunosus macule associated with edema • Prolonged or permanent postinflammatory hyperpigmentation

15. Fixed erythema

16. Fixed erythema

17. Fixed erythema

18. Fixed erythema

19. Morbilliform erythema

20. Morbilliform erythema

21. Urticaria Drug eruption

22. Pityriasis rosea drug eruption

23. Clinical feature of toxic epidermal necrolysis drug eruption Mucosal surface are eroded Severe constitutional symptoms are often associated with high fever Internal organ involvement Coures: 3~4weeks Skin lesions rapidly spread Lesions are macule or purpuric centers form bullae slough

24. Epidermal necrolysis drug eruption

25. Epidermal necrolysis drug eruption

26. Erythema multiform drug eruption

27. Stevens-Johnson syndrome drug eruption

28. Clinical feature of exfoliative dematitis eruption • Has a long incubation period, often over 20days • The symptoms are progressively severe • The diffuse and generalized red macules associated edema, scaly obviously • Has constitutional symptoms • Long course ，for 1~3months or longer

29. Exfoliative dematitis eruption

31. Diagnose • History of administration • Incubation period • Onset：acute or progressively worse • Eruption：morphology，distribution and number • Have or no systemic symptom • Course and prognosis • Skin testing and reexposure test：cautiously evaluate

32. Diagnose Drug eruption must be differentiated from But sometime it is difficult to discriminate Infetious disease Related dermatoses

33. Diagnose Morbilliform drug eruption Scarlatiniform drug eruption Morbilli Scarlatina Differentiated from

34. Koplic macule

35. Strawberry tongue

36. Differential diagnosis Erythema multiform drug eruption Pityriasis rosea drug eruption Urticarial drug eroption Erythema multiform Pityriasis rosea Urticaria Differe ntIated from

37. Prophylaxis • A detailed history from the patient • Be familiar with the structure of drugs, prevent cross-react • No drug abusing，know of medication indicatio • Pay attention to the signs of portent reaction

38. Treatment • Stop the suspected drugs immediately • General measure: keep warm, strengthen nutrition and egestion. • Drugs: anti-allergy, supportive treatment and prevent secondary infections

39. Drug treatment • Mild drug eruptione: antihistamine（may be various combinations），topical application of antipruritic powder or lotion • Moderately severe drug eruption：steroid :prednisone ---dose:30~40mg/d, then reduce the dose according to the symptom • severe forms：take measures as follows:

40. Treatment of severe drug eruption • Corticosteroid：intravenous use: hydrocortisone 200-500mg/d • Supportive treatment：blood transfusion/ medium molecular dextran/ plasma adequate fluid intake • Prevent secondary infections: antibiotic treatment • Pay attention to the fluid and electrolyte balance, especially , especially to sylvite • Treatment to the internal involved • Topical treatment

41. Without oozing oozing Powder \ lotion compresses acute Without oozing oozing emulsion \ lotion paste subacute Topical treatment： skin mucous membrane strengthen nurse of cavity, prevent complication

42. Thanks