《皮肤性病学》课程教学资源（教案）Drug erption

皮肤性病学教案及讲稿General课程名称年级授课专业2006级留学生DermatologyandVeneraolgyContents教师陈爱军职称副教授授课方式大课示教学时2题目章节《Drugeruption》教材名称作者《Dermatovenereology》Liu TongDean's office of Xi'an Jiaotong University出版社版次FirstNovember2004教学to master:Thedefinition of drug eruption1目2.to master:The etiology and pathogenesis of drug eruption的3tomaster:Theclinical manifestations ofdrugeruption.要4.to well known:The treatment of drug eruption.来教学Theetiologyandpathogenesisofdrugeruption1.2.The clinical manifestations of drug eruption.难The treatment of drug eruption点教Thedefinitionof drug eruption学重点1.The clinical manifestations of drug eruption.2.3.The treatment of drug eruption.外语全英语教学要求教学方法大课讲述、多媒体、彩色图谱、临床病例手段参考《临床皮肤病学》赵辨等主编，2001年江苏科学技术出版社资料2.《AnderwsDiseasesofskin》（第九版英文影印版）Richard.B.O等主编，科学出版社教研室意教学组长：单葵教研室主任：李惠见2009年9月17日

皮肤性病学教案及讲稿 课程名称 General Contents 年级 2006 级留学生 授课专业 Dermatology and Veneraolgy 教 师 陈爱军 职称 副教授 授课方式 大课 示教 学时 2 题目章节 《Drug eruption》 教材名称 《Dermatovenereology》 作者 Liu Tong 出 版 社 Dean’s office of Xi’an Jiaotong University November 2004 版次 First 教 学 目 的 要 求 1. to master:The definition of drug eruption. 2. to master:The etiology and pathogenesis of drug eruption. 3. to master:The clinical manifestations of drug eruption. 4. to well known:The treatment of drug eruption. 教 学 难 点 1. The etiology and pathogenesis of drug eruption. 2. The clinical manifestations of drug eruption. 3. The treatment of drug eruption. 教 学 重 点 1. The definition of drug eruption. 2. The clinical manifestations of drug eruption. 3. The treatment of drug eruption. 外语 要求 全英语教学 教学 方法 手段 大课讲述、多媒体、彩色图谱、临床病例 参考 资料 1. 《临床皮肤病学》赵辨等主编，2001 年江苏科学技术出版社 2. 《Anderws Diseases of skin》（第九版英文影印版）Richard.B.O 等主编，科学出版社 教研 室意 见 教学组长： 单葵 教研室主任：李惠 2009 年 9 月 17 日

辅助手段教学内容时间分配Definition2mDrug eruption is also called dermatitis medicamentosa ,medicines Can lead to drugeruptionbymanyways:oral taking,illjectioninhalation,clusis,suppository,oreventiny wound Of skin ; drug eruption always shows inflammatory lesions, it can also effect on8mOther systems in somesevere cases1 mEtiology and pathogenesisThere are two sorts of etiologyOne is individual differenceOHeredityOAllergic constitutionODeficiencyof someenzymes1 mOCondition of the body0OthersThe other reason is medicine itself2 mOEverymedicinecanlead todrugeruption inspecial conditionOAdverse reactions to most medications occur at very low ratesHowever,certain used medications have much higher rates of adverse reactionsCommon drugs in clinic that can induce drug eruption are as follows:OAntibiotics（Penicillin，Sulfanilamide)OAntipyretic and analgesic （Aspirin）OSedatives and hypnotics （Luminal diazepam）OAntiepileptic and antispasmodic（Phenobarbital）OSerumofother species andvaccine3mHowdodrugslead to drugeruption?The real mechanism is unclearThe possible ways are as follows :0One is allergic reaction0The other is non-allergic reactionThere are many features of this type of drug eruption1.It occurs only in some individuals who have allergic constitutions.2.Therapeutic action,toxic reaction and doseof drugsdonotdeterminedegrees of theeruption ;minimum dose of drugs can also induce it when the individual is at high-susceptibility3.Drug eruption has a special latent period, it occurs after about 4 to 20 days if are used at firsttime;the average period is 7to 8 days;but ifdrugs are secondly used,eruption will occur atseveral minute to 24 hours .4.Forms of eruption have no specialties;one drug can lead to similar or different type ofdrug eruptions in one case at different period .1m5,Repeatedly use of similar drugs is able toresult in new drug eruptionand is called crossallergy, when a patient is at high-susceptibility, those drugs that are differentfrom the allergicdrugs are also able to lead to drug eruption and are called polyvalent allergy6. Corticoid is effective to drug eruption after allergic drug having been ceasedNon-allergic reactionODrug induces releasing of inflammatory factors0Overdose reactionOAccumulation reactionOEnzymedeficiencyor SuppressionOToxic reaction of sunlight

教学内容 Definition Drug eruption is also called dermatitis medicamentosa，medicines Can lead to drug eruption by many ways：oral taking，i11jection，inhalation，clusis，suppository，or even tiny wound Of skin；drug eruption always shows inflammatory lesions，it can also effect on Other systems in some severe cases． Etiology and pathogenesis There are two sorts of etiology• One is individual difference Ø Heredity ØAllergic constitution ØDeficiency of some enzymes ØCondition of the body ØOthers The other reason is medicine itself ØEvery medicine can lead to drug eruption in special condition ØAdverse reactions to most medications occur at very low rates. However,certain used medications have much higher rates of adverse reactions Common drugs in clinic that can induce drug eruption are as follows: Ø Antibiotics （Penicillin，Sulfanilamide ） ØAntipyretic and analgesic（Aspirin） ØSedatives and hypnotics （ Luminal diazepam） ØAntiepileptic and antispasmodic （Phenobarbital ） ØSerum of other species and vaccine How do drugs lead to drug eruption? The real mechanism is unclear The possible ways are as follows： Ø One is allergic reaction Ø The other is non—allergic reaction There are many features of this type of drug eruption 1. It occurs only in some individuals who have allergic constitutions． 2. Therapeutic action，toxic reaction and dose of drugs do not determine degrees of the eruption；minimum dose of drugs can also induce it when the individual is at high-susceptibility 3. Drug eruption has a special latent period，it occurs after about 4 to 20 days if are used at first time；the average period is 7 to 8 days；but if drugs are secondly used，eruption will occur at several minute to 24 hours． 4. Forms of eruption have no specialties；one drug can lead to similar or different type of drug eruptions in one case at different period． 5. Repeatedly use of similar drugs is able to result in new drug eruption，and is called cross allergy; when a patient is at high-susceptibility, those drugs that are different from the allergic drugs are also able to 1ead to drug eruption and are called polyvalent allergy． 6. Corticoid is effective to drug eruption after allergic drug having been ceased Non-allergic reaction ØDrug induces releasing of inflammatory factors ØOverdose reaction ØAccumulation reaction ØEnzyme deficiency or Suppression ØToxic reaction of sunlight 辅助手段 时间分配 2m 8 m 1 m 1 m 2 m 3 m 1 m

20 m4 mClinical manifestationsvFixed typeCommon drugsONSAIDOSulfonamidesOBarbiturates and tetracyclineFeatureOlt is round or round alikeOEdema-macule with purple-red colorOThedimension isabout1to4cmOlt always exists solely, sometimes severalOTheborder is clear and roundedwithflushOBut in some severecases,vesicleorbulla will appearon erythemaerosionmayoccuronmucosae folds,or even leadto infectionOProduce ulcersAreasOEruptionalwaysexistsonboundaryof cutisandmucosaelikelipid,aroundlipidandglans.OOther areas are backs of hand,foot and trunk.Systemic symptoms2 mOPatients with fixed drug eruption always feel mild itch and no systemic symptoms .The course of this disease> The erythema will disappear after about 1 week that drugs have been ceased and leave overgrey-black macule ,this grey-black macule will keep for a long time and is not easy to diminish>If ulcer exists, the course of this disease will be delayed .Urticaria typeCommon drugs>Serum3m>Penicillin>And so onFeature>Clinically the lesions are pruritic wheals or angioedema.The course of this disease>If the allergic drug excretes very slowly, urticaria willbe chronicMorbilliform or scarlatiniform typesCommon drugs>Penillin>NSAID>Barbiturates and SMZcoFeature>Erythema,ften with small papules all over the bodyAreas2 m>Lesons appearfirst, especially inthegroinand ailla

Clinical manifestations vFixed type Common drugs ØNSAID ØSulfonamides ØBarbiturates and tetracycline Feature ØIt is round or round alike ØEdema-macule with purple-red color ØThe dimension is about 1 to 4 cm ØIt always exists solely, sometimes several ØThe border is clear and rounded with flush ØBut in some severe cases，vesicle or bulla will appear on erythema，erosion may occur on mucosae folds，or even lead to infection ØProduce ulcers Areas ØEruption always exists on boundary of cutis and mucosae like lipid，around lipid and glans． ØOther areas are backs of hand，foot and trunk． Systemic symptoms ØPatients with fixed drug eruption always feel mild itch and no systemic symptoms． The course of this disease ➢The erythema will disappear after about 1 week that drugs have been ceased and leave over grey-black macule，this grey-black macule will keep for a long time and is not easy to diminish． ➢If ulcer exists, the course of this disease will be delayed． Urticaria type Common drugs ➢Serum ➢Penicillin ➢And so on Feature ➢Clinically the lesions are pruritic wheals or angioedema． The course of this disease ➢If the allergic drug excretes very slowly，urticaria will be chronic Morbilliform or scarlatiniform types Common drugs ➢Penicillin ➢NSAID ➢Barbiturates and SMZco Feature ➢Erythema,often with small papules all over the body Areas ➢Lesions appear first, especially in the groin and axilla 20 m 4 m 2 m 3 m 2 m

> Within 2 to 3 days, it will spread to the whole bodySystemic symptomsThe course of this disease> The course of these diseases will keep for I to 2 weeksNifthe allergic drugshavenotbeen ceased,thesetypes of drug eruptionwill change intcsevereformsEczematoid typeCommon drugs>Penillin1 m> Sulfanilamide>QuinineFeature>Eczematoid eruption will occur: Erythema, papules, papulovesicles and vesicles can befound, the eruption also can confluence and spread to the whole body>Erosion , exudation and desquamation will appearThe course of this disease2 mPurpurictypeCommon drugs>Antibiotics>Barbital>QuinineFeature>Petechia or ecchymosis>Even produce vesicles and exudation on the central of primary lesionsErythema multiforme-like typeFeature>Similar to erythema multiforme : round-like , pea to broad bean in dimension, edema-erythema or papule>The boundary is clear>The central is purple red with vesicle on it>Iris or target lesionAreas>The eruptions always exist on front oflimbs,trunk and mucosae3m>Lesions will spread to the whole bodySystemic symptoms>Itch>Heavy pain> Patients always have high fever>Damages of liver and kidneys>These features are called severe erythema multiforme-like drug eruption, it is easy to causedeath.Bullous type with toxic epidermal necrolysisFeature>First macular

➢Within 2 to 3 days, it will spread to the whole body. Systemic symptoms The course of this disease ➢ The course of these diseases will keep for 1 to 2 weeks ➢If the allergic drugs have not been ceased ，these types of drug eruption will change into severe forms Eczematoid type Common drugs ➢Penicillin ➢Sulfanilamide ➢Quinine Feature ➢Eczematoid eruption will occur: Erythema, papules, papulovesicles and vesicles can be found，the eruption also can confluence and spread to the whole body ➢Erosion，exudation and desquamation will appear The course of this disease Purpuric type Common drugs ➢Antibiotics ➢Barbital ➢Quinine Feature ➢Petechia or ecchymosis ➢Even produce vesicles and exudation on the central of primary lesions Erythema multiforme-like type Feature ➢Similar to erythema multiforme：round-like，pea to broad bean in dimension, edema￾erythema or papule ➢The boundary is clear ➢The central is purple red with vesicle on it ➢Iris or target lesion Areas ➢The eruptions always exist on front of limbs，trunk and mucosae ➢Lesions will spread to the whole body Systemic symptoms ➢Itch ➢Heavy pain ➢Patients always have high fever ➢Damages of liver and kidneys ➢These features are called severe erythema multiforme-like drug eruption, it is easy to cause death． Bullous type with toxic epidermal necrolysis Feature ➢First macular 1 m 2 m 3 m

>Followed by desquamation> Then loose vesicles and bulla appear on3m>The Nikolsky' sign (+) mild external compression can easily induce erosion and form alarge range of epidermis brisement>similar as superficial second-degree burn.Systemicsymptoms>Pains are outstanding>High fever can also appear>This type of drug eruption can lead to death by secondary infection, disorders of liver andkidneysExfoliative dermatitis-like typeFeature>Eruptions can bemorbillform or scarlatiniform>Then form widespread erythema and swell on the whole body>It can also appear as vesicles, erosions and a small quantity of exudations.>Afterabout 2to3 weeks,erythema and swellingdisappear and accompanied bylarge amount5mofscales>Degloving and de-stocking injury can be seen on hands and feetSystemic symptoms>Superficial lymph node tumefaction of the whole body will occur5 m>Drug-induced hepatitis can also existThe course of thisdisease>Commonly occurs aftera long timemedication.The latent period is about 20 days>Course of this type willkeep for a long time, if the allergic drug were not ceasedimmediately or if it were not treated in time, patients will die.Laboratory tests and other testsTests in vitro25m>Tests in vitro are quite safe5m>But the results are not stableDiagnosis>Clear history of medication>Having an incubation period5m>Symmetrical eruptions except forfixed drug eruption>Lesions being bright-colored>ItchElimination of other diseases (which have eruptions)Treatment10 m>The allergic and suspicious orsimilar drugs must be stopped>Try to accelerate the drug excretion> Pay attention to cross reaction and polyvalent allergy.Treatment ofmilddrug eruption>Anti-histamine drug and vitamin C can be effective>Sometimes-moderate dose of prednisone (30 to 60mg) is needed, it must be stoppedgraduallyafter eruptions disappeal

➢Followed by desquamation ➢Then loose vesicles and bulla appear on ➢The Nikolsky’ sign (+) mild external compression can easily induce erosion and form a large range of epidermis brisement ➢Similar as superficial second-degree burn. Systemic symptoms ➢Pains are outstanding ➢High fever can also appear ➢This type of drug eruption can lead to death by secondary infection, disorders of liver and kidneys Exfoliative dermatitis-like type Feature ➢Eruptions can be morbilliform or scarlatiniform ➢Then form widespread erythema and swell on the whole body ➢It can also appear as vesicles, erosions and a small quantity of exudations. ➢After about 2 to 3 weeks, erythema and swelling disappear and accompanied by large amount of scales ➢Degloving and de-stocking injury can be seen on hands and feet Systemic symptoms ➢Superficial lymph node tumefaction of the whole body will occur ➢Drug-induced hepatitis can also exist The course of this disease ➢Commonly occurs after a long time medication．The latent period is about 20 days ➢Course of this type will keep for a long time, if the allergic drug were not ceased immediately or if it were not treated in time, patients will die. Laboratory tests and other tests Tests in vitro ➢Tests in vitro are quite safe ➢But the results are not stable Diagnosis ➢Clear history of medication ➢Having an incubation period ➢Symmetrical eruptions except for fixed drug eruption ➢Lesions being bright-colored ➢Itch ➢Elimination of other diseases (which have eruptions) Treatment ➢The allergic and suspicious or similar drugs must be stopped ➢Try to accelerate the drug excretion ➢Pay attention to cross reaction and polyvalent allergy. Treatment of mild drug eruption ➢Anti-histamine drug and vitamin C can be effective ➢Sometimes-moderate dose of prednisone (30 to 60mg) is needed, it must be stopped gradually after eruptions disappear 3 m 5 m 5 m 25 m 5 m 5 m 10 m