Clinical, Allergological and Venereological Dermatology Section Department of Medicine University of Perugia, Perugia, Italy -
G Ital Dermatol Venereol. 2014 Apr;149(2):237-41.
Exanthematic eruptions, together with urticaria-angioedema syndrome and fixed drug eruption, are the most frequent cutaneous adverse drug reactions. Among the drug-induced exanthems (DIEs), erythematous maculopapular eruptions are the most common. Their management, especially when retrospective, is often not easy, and it is based on the use of clinical criteria, history, results of some laboratory tests, drug elimination test, skin tests, and oral challenge test. The superficial perivascular and spongiotic dermatitis, which is the prevalent histopathological features of DIEs, is not very useful in the differential diagnosis with virus- and bacteria-induced exanthems (VBIEs). On the contrary, some immune-histochemical findings (interleukin-5 overexpression, concomitant enhancement of perforin, interleukin-5, and granzyme B production, positivity for fatty acid synthase-ligand-L in amoxicillin-induced exanthems) seem to be more important. These data justifie the inclusion of DIEs in the subtypes IVb and IVc of delayed hypersensitivity reactions.
发疹性皮疹，连同荨麻疹-血管性水肿综合征和固定性药物疹，是最常见的皮肤药物不良反应。在药物诱导的发疹性疾病（DIE）中，红斑性斑丘疹性皮疹最为常见。这些疾病的治疗，特别是回顾性治疗，往往并不容易，其依据是临床标准、病史、一些实验室检查结果、药物消除试验、皮肤试验和口服挑战试验。弥漫性血管周围和海绵状皮炎是 DIE 的主要组织病理学特征，但对于与病毒和细菌诱导的皮疹（VBIE）的鉴别诊断并没有太大帮助。相反，一些免疫组织化学发现（白细胞介素 5 过度表达、穿孔素、白细胞介素 5 和颗粒酶 B 生成的同时增强、阿莫西林诱导的皮疹中脂肪酸合酶配体-L 的阳性）似乎更为重要。这些数据证明 DIE 属于迟发性超敏反应的 IVb 和 IVc 亚型。
