Dermatologist np, Wapserveen, The Netherlands.
Contact Dermatitis. 2022 Mar;86(3):145-164. doi: 10.1111/cod.14016. Epub 2021 Dec 27.
The literature on systemic allergic dermatitis (SAD; also known as systemic contact dermatitis) is reviewed. Both topical drugs (from absorption through mucosae or skin) and systemic drugs (oral, parenteral, rectal) may be responsible for the disorder. The topical route appears to be rare with 41 culprit topical drugs found to cause SAD in 95 patients. Most reactions are caused by budesonide (especially from inhalation), bufexamac, and dibucaine. SAD from systemic drugs is infrequent with 95 culprit drugs found to cause SAD in 240 patients. The drugs most frequently implicated are mitomycin C, methylprednisolone (salt, ester), and hydrocortisone (salt). The largest group of culprit drugs consisted of corticosteroids (19%), being responsible for >30% of the reactions, of which nearly 40% were not caused by therapeutic drugs, but by drug provocation tests. The most frequent manifestations of SAD from drugs are eczematous eruptions (scattered, widespread, generalized, worsening, reactivation), maculopapular eruptions, symmetrical drug-related intertriginous and flexural exanthema (SDRIFE [baboon syndrome]) and widespread erythema or erythroderma. Therapeutic systemic drugs hardly ever cause reactivation of previously positive patch tests and infrequently of previous allergic contact dermatitis. The pathophysiology of SAD has received very little attention. Explanations for the rarity of SAD are suggested.
本文回顾了全身性过敏性皮炎（SAD；也称为全身性接触性皮炎）的文献。局部药物（通过黏膜或皮肤吸收）和全身药物（口服、注射、直肠）都可能导致这种疾病。局部途径似乎很少见，有 41 种局部药物在 95 例患者中引起 SAD。大多数反应是由布地奈德（特别是吸入）、布非昔单抗和丁卡因引起的。全身性药物引起的 SAD 很少见，有 95 种全身药物在 240 例患者中引起 SAD。最常涉及的药物是丝裂霉素 C、甲泼尼龙（盐、酯）和氢化可的松（盐）。最常见的致病药物是皮质类固醇（19%），占反应的 30%以上，其中近 40%不是由治疗药物引起的，而是由药物激发试验引起的。药物引起的 SAD 最常见的表现是湿疹样皮疹（分散、广泛、全身性、加重、再激活）、斑丘疹、对称药物相关性间擦疹和皱褶部疹（SDRIFE [狒狒综合征]）和广泛的红斑或红皮病。治疗性全身药物很少引起先前阳性斑贴试验的再激活，也很少引起先前的过敏性接触性皮炎。SAD 的病理生理学很少受到关注。本文提出了导致 SAD 罕见的一些原因。
