Błaszczyk Barbara, Lasoń Władysław, Czuczwar Stanisław Jerzy
Faculty of Health Sciences, High School of Economics, Law and Medical Sciences, Kielce, Poland; Private Neurological Practice, Kielce, Poland.
Department of Experimental Neuroendocrinology, Institute of Pharmacology, Polish Academy of Sciences, Kraków, Poland.
Pharmacol Rep. 2015 Jun;67(3):426-34. doi: 10.1016/j.pharep.2014.11.009. Epub 2014 Nov 27.
This paper summarizes current views on clinical manifestation, pathogenesis, prognosis and management of antiepileptic drug (AED)-induced adverse skin reactions. Cochrane Central Register of Controlled Trials, MEDLINE (PubMed) and ISI Web of Knowledge were searched. The recent classification, among drug-induced skin injuries, points to Stevens-Johnson syndrome/toxic epidermal necrolysis (SJS/TEN), acute generalized exanthematous pustulosis and hypersensitivity syndrome (HSS), which may be also recognized as a drug reaction with eosinophilia and systemic symptoms (DRESS) or drug-induced hypersensitivity syndrome (DIHS). The use of aromatic AEDs, e.g. phenytoin, carbamazepine, oxcarbazepine, phenobarbital, primidone, zonisamide, and lamotrigine is more frequently associated with cutaneous eruption and other signs or symptoms of drug hypersensitivity. There is a high degree of cross-reactivity (40-80%) in patients with hypersensitivity or allergic reactions to AEDs. Pharmacogenetic variations in drug biotransformation may also play a role in inducing these undesired effects. It is suggested that avoidance of specific AEDs in populations at special risk, cautious dose titration and careful monitoring of clinical response and, if applicable, laboratory parameters can minimize the serious consequences of idiosyncratic reactions.
本文总结了目前关于抗癫痫药物（AED）所致皮肤不良反应的临床表现、发病机制、预后及处理的观点。检索了Cochrane对照试验中心注册库、MEDLINE（PubMed）和ISI科学网。在药物性皮肤损伤中，近期的分类指出了史蒂文斯-约翰逊综合征/中毒性表皮坏死松解症（SJS/TEN）、急性泛发性脓疱性皮病和超敏反应综合征（HSS），后者也可被认为是伴有嗜酸性粒细胞增多和全身症状的药物反应（DRESS）或药物性超敏反应综合征（DIHS）。使用芳香族AED，如苯妥英、卡马西平、奥卡西平、苯巴比妥、扑米酮、唑尼沙胺和拉莫三嗪，更常与皮疹及药物超敏反应的其他体征或症状相关。对AED过敏或发生超敏反应的患者存在高度交叉反应（40%-80%）。药物生物转化中的药物遗传学变异也可能在诱发这些不良反应中起作用。建议在特殊风险人群中避免使用特定的AED，谨慎进行剂量滴定，并仔细监测临床反应以及（如适用）实验室参数，以尽量减少特异反应的严重后果。
