Rayala Brian Z, Morrell Dean S
University of North Carolina Chapel Hill School of Medicine Department of Family Medicine, 590 Manning Drive, Chapel Hill, NC 27599.
University of North Carolina Chapel Hill School of Medicine Dermatology Residency Program, 410 Market St. Suite 400 CB#7715, Chapel Hill, NC 27516.
FP Essent. 2017 Feb;453:18-25.
Cutaneous adverse drug reactions are among the most common noninfectious rashes of childhood. Cutaneous adverse drug reactions are classified as morbilliform, urticarial, bullous, pustular, or psoriasiform. Atopic dermatitis is one of the most common inflammatory cutaneous eruptions, and is characterized by pruritus and flexural distribution. Emollients and topical corticosteroids are first-line therapies. Topical calcineurin inhibitors are second-line, steroid-sparing drugs for certain conditions, such as face and eyelid eczema. Systemic and immunologic conditions have mucocutaneous features, such as malar rash, discoid lupus, and photosensitivity in systemic lupus erythematosus; lip, oral, and extremity changes as well as polymorphous rash in Kawasaki disease; erythematous, scaly plaques in psoriasis; and xerosis and face, hand, and leg skin changes in type 1 diabetes. Genetic conditions that manifest as changes in skin pigmentation are important to recognize because of the thorough diagnostic evaluation they warrant, the often challenging interventions they necessitate, and the permanent disability that frequently accompanies them. These conditions include neurofibromatosis, LEOPARD syndrome, incontinentia pigmenti, congenital hemidysplasia with ichthyosiform erythroderma and limb defects syndrome, hypomelanosis of Ito, and acanthosis nigricans. Childhood dermatologic emergencies often are associated with infection and drugs and require early recognition and intervention.
皮肤药物不良反应是儿童期最常见的非感染性皮疹之一。皮肤药物不良反应可分为麻疹样、荨麻疹样、大疱性、脓疱性或银屑病样。特应性皮炎是最常见的炎症性皮肤疹之一,其特征为瘙痒和屈侧分布。润肤剂和外用糖皮质激素是一线治疗方法。外用钙调神经磷酸酶抑制剂是某些情况下(如面部和眼睑湿疹)的二线、节省类固醇的药物。全身性和免疫性疾病具有黏膜皮肤特征,如系统性红斑狼疮中的蝶形红斑、盘状狼疮和光敏性;川崎病中的唇部、口腔和肢体变化以及多形性皮疹;银屑病中的红斑鳞屑斑块;以及1型糖尿病中的皮肤干燥和面部、手部及腿部皮肤变化。表现为皮肤色素沉着改变的遗传性疾病很重要,因为它们需要全面的诊断评估、往往具有挑战性的干预措施以及常常伴随的永久性残疾。这些疾病包括神经纤维瘤病、豹皮综合征、色素失禁症、先天性半侧发育不良伴鱼鳞病样红皮病和肢体缺损综合征、伊藤色素减退症以及黑棘皮病。儿童皮肤科急症通常与感染和药物有关,需要早期识别和干预。