University of Western Ontario, Schulich School of Medicine and Dentistry, London, ON, Canada.
CNS Drugs. 2011 Jul;25(7):575-83. doi: 10.2165/11592230-000000000-00000.
Alzheimer's disease is a chronic neurodegenerative disorder resulting in part from the degeneration of cholinergic neurons in the brain. Rivastigmine, a cholinesterase inhibitor, is commonly used as a treatment for dementia due to its ability to moderate cholinergic neurotransmission; however, treatment with oral rivastigmine can lead to gastrointestinal adverse effects such as nausea and vomiting. Transdermal administration of rivastigmine can minimize these adverse effects by providing continuous delivery of the medication, while maintaining the effectiveness of the oral treatment. While the transdermal form of rivastigmine has been found to have fewer systemic adverse effects compared with the oral form, cutaneous reactions, such as contact dermatitis, can lead to discontinuation of the drug in its transdermal form. Lack of patient compliance with regard to applying the patch to the designated site, applying the patch for the correct length of time or rotating patch application sites increases the risk of cutaneous adverse reactions. This article outlines the diagnosis and management of irritant contact dermatitis and allergic contact dermatitis secondary to transdermal rivastigmine. The large majority of reactions to transdermal patches are of an irritant type, which can be diagnosed clinically by the presence of a pruritic, erythematous, eczematous plaque strictly confined to the borders of the patch. In contrast, an allergic reaction can be differentiated by the presence of vesicles and/or oedema, erythema beyond the boundaries of the transdermal patch and lack of improvement of the lesion 48 hours after removal of the offending treatment. By encouraging the patient to follow a regular rotation schedule for the patch, and using lipid-based emollients for irritant dermatitis and pre- and post-treatment topical corticosteroids for allergic dermatitis, cutaneous reactions can often be alleviated and patients can continue with their medication regimen. Other simple changes to a patient's treatment routine, including minimizing the use of harsh soaps, avoiding recently shaven or damaged areas of skin and carefully removing the patch after use, can help to further decrease the risk of dermatitis development.
阿尔茨海默病是一种慢性神经退行性疾病，部分原因是大脑中的胆碱能神经元退化。rivastigmine 是一种胆碱酯酶抑制剂，由于其能够调节胆碱能神经传递，因此通常被用作痴呆症的治疗药物；然而，口服 rivastigmine 治疗会导致胃肠道不良反应，如恶心和呕吐。经皮给予 rivastigmine 可以通过持续输送药物来最小化这些不良反应，同时保持口服治疗的有效性。虽然与口服形式相比，rivastigmine 的经皮形式具有较少的全身不良反应，但皮肤反应，如接触性皮炎，可导致其经皮形式的药物停用。患者在指定部位贴敷贴片、正确贴敷贴片的时间或贴片贴敷部位的旋转方面缺乏依从性会增加皮肤不良反应的风险。本文概述了经皮 rivastigmine 引起的刺激性接触性皮炎和过敏性接触性皮炎的诊断和管理。绝大多数对经皮贴片的反应为刺激性类型，可通过存在瘙痒、红斑、湿疹斑块且严格局限于贴片边界来临床诊断。相比之下，过敏反应可通过存在水疱和/或水肿、贴片边界以外的红斑以及去除致病治疗后 48 小时内病变未改善来区分。通过鼓励患者遵循贴片的定期旋转方案，并在刺激性皮炎中使用基于脂质的保湿剂，在过敏性皮炎中使用贴片前和贴片后的局部皮质类固醇，可以缓解皮肤反应，使患者能够继续他们的药物治疗方案。患者治疗常规的其他简单改变，包括尽量减少使用刺激性肥皂、避免最近刮过或受损的皮肤区域以及在使用后小心地去除贴片，都可以帮助进一步降低皮炎发展的风险。
