蕁麻疹、藥疹英文版課件

1、URTICARIASynonyms: hives, nettle rashUrticaria is a vascular reaction of the skin characterized by the appearance of wheals, which are elevated, whitish or reddish evanescent plaques, generally surrounded by a real halo or flare, and associated with severe itching, stinging, or pricking sensations.*

2、1urticaria2EtiologyThe causes of cases cannot be found. a. Food b. Drugs: penicillin, serum products, etc c. Infection: virus, bacteria, fungus, parasite d. Physical factor: cold, heat, sunlight, friction, pressure e. Animals and plants f. Mental factors g. Internal and systemic diseases3Mechanism1.

3、 Allergic reaction: Type for most conditions (B cell: Ig E, mast cell around blood vessels and basophilic cell, histamine and kinins ), occasionally type and type 2. Non-allergic reaction: Complements are activated, or mast cells are irritated to secrete histamine and kinins (drugs, toxin, food)4Cli

4、nical features1. Acute urticaria: Acute wheals in different size, shape and portion, persist less than 24 hs, but recurrent frequently. For severe cases, not only wheals but also having dyspnea, or like acute abdomen, having abdominal pain, diarrhea, vomiting, or when with severe infection, having h

5、igh fever, chill etc. general toxemic symptom. 2. Chronic urticaria: wheals recur daily over a six or more week period 5圖例6Clinical features: Special typesDermatographism (factitious urticaria)2. Cold urticaria: family, acquired3. Cholinergic urticaria4. Solar urticaria5. Pressure urticaria6. Angioe

6、dema: acquired, genetic (lip, eyelid, genitals) 7圖例8圖例9Glottol angio-oedema10DiagnosisEruption is wheal, and quickly appear and disappear fast with no trace leaving.2. Difficult to find causes (history, physical examination, complete evaluation)11Differentiation DiagnosisPapular urticaria2. Urticari

7、a vasculitis3. Acute abdomen and gastroenteritis in the case with abdominal pain, diarrhea, vomiting4. Severe infection for the case with high fever and toxemic symptom12TreatmentSystemic treatment a. Acute urticaria: antihistamine (1st, 2nd), V-C, calcium agent, probanthine, 654-2, atropine for spa

8、sm b. Chronic urticaria: antihistamines2. Topical treatment Antipruritic agents, calamine, H2 receptor antagonist 13TreatmentFor the case with shock: 0.1% sol. adrenaline 0.3-0.5 ml, subcutaneous injection; aminophylline for bronchospasm; hydrocortisone + vitamin C in 5-10 % sol. Glucose; antibiotic

9、s for infection; recently, tracheotomy is not advocated for dyspnea due to laryngeal edema.14DRUG ERUPTION(Dermatitis medicamentosa)Drug eruptions are produced by taking drug, injection, aspirating, enema, using suppository, even through ruptured skin. The eruptions are mainly caused on skin and muc

10、ous membrane, and other system of body such as blood system, urea system (kidney), digest system (liver). 15EtiologyIndividual factor: heredity, hypersensitive constitution, enzyme defect2. Drug factor: any medicine, at certain condition, may be able to induce drug eruption, but the potential of cau

11、sing drug eruption is different in every medicine.16Etiology: common causative medicineAntibiotics: penicillin, streptomycin, ampicillin, chloromycitin, terramycin (oxytetracycline), sulfanilamide SMZ Co.2. Analgesic-antipyretic: aspirin, aminopyrine, phenacetin3. Sedative, antiepileptic: phenobarbi

12、tal, miltown, tardan, phenytoin sodium4. Heterogeneous serum preparations and vaccine: tetanus antitoxin (TAT), venin-immune serum, rabies-vaccine5. Traditional Chinese medicine17Mechanism: Allergic reactionType I: urticaria, angioneuro-edema, anaphylactic shock or allergic shock (penicillin et al.)

13、2. Type II: hemolytic anemia, thrombocytopenic purpura, granulocytopenia (quinine,感冒通)3. Type III: serum sickness, serum sickness-like syndrome, vasculitis, urticaria, glomerulonephritis (penicillin et al.)4. Type IV: eczematoid and morbilliforme drug eruption, exfoliative dermatitis (penicillin et

14、al.)18Features of Allergic drug eruptionSmall group of persons2. Not related with pharmacologic effects, not parallel with the amount of drug taken 3. Incubation period or latent period being 4-20 days, most 7-8 days4. Multiform eruptions5. Cross-sensitization and polyvalent sensitization6. Steroids

15、 are effective19Mechanism: Non-allergic reactionRelease inflammatory mediator2. Over-dose3. Cumulative actions4. Phototoxic reaction5. Enzyme defect or inhibition20Clinical Features: Multiform manifestationsFixed drug eruption - analgesic-antipyretic, sulfanilamide, barbital - mouth, penis and other

16、 area - round or ellipse, edematous, dark, red macule, 1-4 cm in diameter, one or more, well-defined, surrounded with red halo; In severe case, vesicle or bullae, even erosion with exudation on mucosa may appear - repeat at the same area with pigmentation - itching, disappear in a week after giving

17、up the causative medicine21222324Clinical Features:2. Urticaria - Heterogeneous serum preparations (tetanus antitoxin (TAT), rabies-vaccine), 痢特靈, penicillin - wheal with remark itching, serum sickness-like syndrome: fever, arthralgia, enlarge of lymph node, angioedema, even protein urine252627Clini

18、cal Features:3. Morbilliform or scarlatiniform erythema - penicillin, analgesic-antipyretic, barbital, sulfanilamide - Morbilliform: pin-like red macule or maculopapular, symmetrical, generalized distributing, dominant in trunk; Scarlatiniform: small pieces of erythema from face, neck to upper arm a

19、nd trunk in 2-3 days, distributing all the body and merging with face and four extremities swelling, similar to the the scarlet fever, especially in crease area and the flexion side of four extrimities - suddenly onset, fever, 1-2 week duration 28293031Clinical Features:4. Eczema type - Topical peni

20、cillin, streptomycin, sulfanilamide, quinine CD, skin sensitized; Using again the same or one similar in chemical structure eczema-like eruption - different-sized erythema, papule, papulovesicle and vesicle accompany with erosion, exudation, scaling, generally distribution; patch, long course323334C

21、linical Features:5. Purpura type - antibiotics, barbital, miltown, diuretic, quinine - Type II allergic reaction thrombocytopenic purpura; Type III vasculitis - red petechia, ecchymosis, scattered or dense distribution, elevated, not disappearing when pressing; sometimes, having wheal or vesicle or

22、blood vesicle - both lower legs; For severe case, four extremities and trunk could be involved with article swelling and pain, abdominal pain, blood urine, hematochezia, mucous bleeding, anemia 35圖例36Clinical Features:6. Multiform erythema type - sulfanilamide, analgesic-antipyretic, barbital - roun

23、d or ellipse edematous erythema, papule or vesicle with central dark red, iris phenomenon (+), - four extremities, trunk, mouth, genetic mucous membrane - Severe multiform erythema drug eruption: erythema, papule, vesicle, bullae, erosion, exudation, on mouth, eye, anus, genetic with pain, high feve

24、r, WBC, disturbance in kidney and liver, secondary infection 3738圖例39圖例40Clinical Features:7. Epidermolysis bullosa type (severe) - sulfanilamide, analgesic-antipyretic, antibiotics, barbital - acute onset, generalized dark erythema and loosen vesicle and bulla, Nikolsky sign (+), large area of eros

25、ion with a large amount of exudation like fire burn superficial II - marked touch pain, general (constitutional) symptom (fever, fatigued, nausea, vomiting, diarrhea), secondary infection, disturbance of liver and kidney, disturbance of electrolyte, internal bleeding, protein urine, even azotemia an

26、d dead41428. Exfoliative dermatitis type (severe) - Sulfanilamide, antiepileptic (phenobarbital etc.) analgesic-antipyretic, antibiotics, barbital - Onset after long-term of using drug, incubation period about 20 days, could developing to other types of drug eruption. - At first, the lesions are mor

27、billiform or scarlatiniform, and become severe gradually; general redness, swelling, papulovesicles with erosion, small amount of exudation. About 2-3 weeks later, the swelling disappears with a large amount of scaling and even stock-like exfoliations on hands and feet. The hair and nail may lose. L

28、ips, mouth, eyes may be involved. With superficial lymph node enlarging, bronchial pneumonia, pharmaceutical hepatitis, WBCor, finally may be died of general exhaustion (failure) or secondary infection.4344454647Clinical Features:9. Acniform eruption - Iodine, bromine, steroids, contraceptive, isoni

29、azid (rimifon) - Follicular papule, papulopustule on face, chest and back.48Clinical Features:10. Photosensitization - wintermin, sulfanilamide, tetracycline, griseofulvin, psoralen, 8-methoxypsoralen (8-MOP), 喹諾酮類, phenothiazine, contraceptive - phototoxic erythema: 7-8 hs after exposing light, les

30、ion limited to exposed area - photoallergic eruption: small group person, incubation period, not only limited to the exposed area495051DiagnosisHistory2. Incubation period3. Symmetrical, bright red color4. Severe itching5. Rule out the possibility of other diseases with similar lesions52Differentiat

31、ion Diagnosis1. Measles (Koplik macule) and scarlet fever (red edematous tonsil, red strawberry tongue, “sandpaper” skin, “Pastias lines) - Morbilliform or scarlatiniform erythema2. Staphylococcal scalded skin syndrome (SSSS) - Epidermolysis bullosa type 3. Genital herpes, chancre Fixed drug eruption53Laboratory ExaminationIn vivo test: skin test, scratch test, intradermal test, prick test, patch test2. In vitro test: many 54TreatmentStop using the causative drug, Drink more water, Prevent cross-sensitization and polyvalent (poly-allergen) sensitization55Tre