Ziemer M
Klinik für Dermatologie, Venerologie und Allergologie, Universität Leipzig, Philipp-Rosenthal-Str. 23, 04103, Leipzig, Deutschland,
Hautarzt. 2014 May;65(5):397-408. doi: 10.1007/s00105-013-2696-9.
Cutaneous reactions to drugs can be subdivided in different ways. In addition to the standard classification according to the etiopathogenesis there are also classifications based predominantly on morphological criteria. The majority of drug-related cutaneous adverse reactions are immunological reactions which are collectively classified under the term hypersensitivity. These reactions are based on drug-specific immunoglobulin E (IgE) or cell-mediated mechanisms, not on the mechanism of action of the drug and are unpredictable. Delayed type reactions to drugs are forms of type IV T-cell mediated hypersensitivity. A prerequisite is a stable association of a pharmaceutical substance with a protein so that hapten-protein conjugates can be produced. The most common clinical symptom is maculopapular (morbilliform) drug-related exanthema. This article also examines lichen planus like drug reaction and drug-induced (hematogenic) allergic contact dermatitis in more detail.
The diagnostics are never trivial but also include the differentiation from viral exanthema and initial phases of severe cutaneous adverse reactions, such as toxic epidermal necrolysis. In addition to the morphological classification, the final diagnosis encompasses the interpretation of histopathological alterations in the skin biopsy, analysis of patient medication history, laboratory results and inclusion of data from the literature. Patch tests can also have additional diagnostic benefits. In vitro tests which involve the cellular incubation of the drug responsible should be reserved for specialized laboratories. A prerequisite for successful treatment is immediate termination of the drug responsible.
Therapy is symptomatic with topical and also short-term systemic steroids and antihistamines. The prognosis is very good.
药物引起的皮肤反应可以有不同的分类方式。除了根据病因发病机制进行的标准分类外，还有主要基于形态学标准的分类。大多数与药物相关的皮肤不良反应是免疫反应，统称为超敏反应。这些反应基于药物特异性免疫球蛋白E（IgE）或细胞介导机制，而非药物的作用机制，且无法预测。药物迟发型反应是IV型T细胞介导的超敏反应形式。一个先决条件是药物与蛋白质稳定结合，从而产生半抗原-蛋白质结合物。最常见的临床症状是斑丘疹（麻疹样）药物相关疹。本文还更详细地探讨了扁平苔藓样药物反应和药物性（血源性）过敏性接触性皮炎。
诊断绝非易事，还包括与病毒疹以及严重皮肤不良反应（如中毒性表皮坏死松解症）的初始阶段相鉴别。除形态学分类外，最终诊断还包括对皮肤活检组织病理学改变的解读、患者用药史分析、实验室结果以及文献数据的纳入。斑贴试验也可能有额外的诊断益处。涉及对相关药物进行细胞培养的体外试验应留给专业实验室。成功治疗的一个先决条件是立即停用相关药物。
治疗采用局部和短期全身性类固醇及抗组胺药进行对症治疗。预后非常好。
