Cutaneous drug reactions

Danh pháp . Nhiếm độc dị ứng thuốc ( Toxiderrmie ). Dị ứng thuốc ( Allergie cutanée de medicamenteuse) Phản ứng thuốc ( Adverse cutaneous drug reaction - ACDRS). 1.2.Tình hình: Phản ứng thuốc khá thường gặp chiếm khoảng 2-3 % số bệnh nhân điều trị nôi trú. Nếu tính toàn bộ các biến chứng do thuốc điều trị ở bệnh nhân nội trú tỉ lệ lên tới 19 %. Phần lớn các phản ứng thuốc là nhẹ kèm theo có chứng ngứa và khỏi sau khi ngừng uống thuốc đã gây nên tình trạng dị ứng. Tuy nhiên một số...

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Natural photoprotection is provided by structural proteins in the epidermis, particularly keratins and melanin. The amount of melanin and its distribution in cells is genetically regulated, and individuals of darker complexion (skin types IV–VI) are at decreased risk for the development of acute sunburn and cutaneous malignancy. Other forms of photoprotection include clothing and sunscreens. Clothing constructed of tightly woven sun-protective fabrics, irrespective of color, affords substantial protection. Wide-brimmed hats, long sleeves, and trousers all reduce direct exposure.

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Sulfonamides Antibacterial sulfonamides have a rather high risk of causing cutaneous eruptions and are among the drugs most frequently implicated in SJS and TEN. The combination of sulfamethoxazole and trimethoprim frequently induces adverse cutaneous reactions in patients with AIDS (Chap. 182). Desensitization is often successful in AIDS patients with morbilliform eruptions but is not recommended in AIDS patients who manifested erythroderma or a bullous reaction in response to their earlier sulfonamide exposure.

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Allopurinol Together with sulfonamides and antiepileptics, allopurinol is one of the "usual suspects" that induce frequently mild maculopapular eruptions (in at least 3% of users) and may also cause more severe reactions including hypersensitivity/DRESS and SJS/TEN. Because of increasing utilization it is one of the most frequent causes of life-threatening reactions. Anti-HIV Medications In clinical trials, combinations of highly active antiretroviral treatments were frequently associated with ≥10% "drug eruptions.

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Onychomadesis Onychomadesis is caused by temporary arrest of nail matrix mitotic activity. Common drugs reported to induce onychomadesis include carbamazepine, lithium, retinoids, and chemotherapeutic agents such as cyclophosphamide and vincristine. Paronychia Paronychia and multiple pyogenic granuloma with progressive and painful periungual abscess of fingers and toes are a side effect of systemic retinoids, lamivudine, indinavir, and anti-EGFR monoclonal antibodies (cetuximab, gefitinib).

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These reactions are characterized by one or more sharply demarcated, erythematous lesions, sometimes leading to a blister. Hyperpigmentation results after resolution of the acute inflammation. With rechallenge, the lesion recurs in the same (i.e., fixed) location. Lesions often involve the lips, hands, legs, face, genitalia, and oral mucosa and cause a burning sensation. Most patients have multiple lesions. Fixed drug eruptions have been associated with phenolphthalein, sulfonamides, cyclines, dipyrone, NSAIDs, and barbiturates.

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Delayed hypersensitivity mechanisms directed by drug-specific T cells are probably the most important mechanisms in the etiology of the most common drug eruptions—morbilliform exanthems—and also of rare and severe forms such as hypersensitivity syndrome, acute generalized exanthematous pustulosis (AGEP), Stevens-Johnson syndrome (SJS), and toxic epidermal necrolysis (TEN). Drugspecific T cells have been detected in these types of drug eruptions. Contrary to what has been believed for years, the antigen is more often the native drug itself than its metabolites.

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Untoward cutaneous responses to drugs can arise as a result of immunologic or nonimmunologic mechanisms. A variety of adverse reactions result from mechanisms that do not involve an immunologic process. Drug reactions are a public health problem because of their frequent occurrence, occasional severity, and impact on the use of medications. The skin is among the organs most often affected by adverse drug reactions. The list of conditions that can be triggered by medications includes nearly all dermatologic diseases.

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Harrison's Internal Medicine Chapter 56. Cutaneous Drug Reactions CUTANEOUS DRUG REACTIONS: INTRODUCTION Cutaneous reactions are among the most frequent adverse reactions to drugs. Every physician will see patients suffering from them. Most are benign, but a few can be life-threatening. Prompt recognition of severe reactions, drug withdrawal, and appropriate therapeutic interventions can minimize toxicity.

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1.1. Danh pháp . Nhiếm độc dị ứng thuốc ( Toxiderrmie ). Dị ứng thuốc ( Allergie cutanée de medicamenteuse) Phản ứng thuốc ( Adverse cutaneous drug reaction - ACDRS). 1.2.Tình hình: Phản ứng thuốc khá thường gặp chiếm khoảng 2-3 % số bệnh nhân điều trị nôi trú. Nếu tính toàn bộ các biến chứng do thuốc điều trị ở bệnh nhân nội trú tỉ lệ lên tới 19 %. Phần lớn các phản ứng thuốc là nhẹ kèm theo có chứng ngứa và khỏi sau khi ngừng uống thuốc đã gây nên tình trạng dị ứng. Tuy nhiên một...

7p hibarbie 18-09-2010 140 20   Download