我是如何处理重型药疹的

How I Treat Severe Cutaneous Adverse Drug Reactions

危及生命的重型药疹主要包括SJS和TEN、高敏综合征(HSS,又称DRESS)。由于它们的病因不同,因此处理也要不同。TEN的病因最为单纯,一般均由药物引起,SJS中仅有50%由药物引起;而DRESS则明确是病毒与药物的共同作用引起,药物与病毒是导致DRESS发生的"共因子(co-factor)"。导致重型药疹发生并发症和后遗症的主要因素是大剂量、长时期的使用糖皮质激素(GC),在导致患者死亡的原因中除了疾病本身的因素外,GC的不恰当使用也是主要原因之一。作者将自己处理、治疗以上三种不同类型药疹的方法、要点、预防并发症、后遗症和降低死亡率的手段进行了介绍,还介绍了DRESS后引起自身免疫病的现象和机制。

Severe life-threatening cutaneous adverse reactions（ SCAR） mainly include Stevens-Johnson syndrome（ SJS）,toxic epidermal necrolysis（ TEN） and hypersensitivity syndrome（ HSS）. The latter is also called drug rash with eosinophilia and systemic symptoms（ DRESS）. These diseases should be treated differently due to their pathogenic differences. Regarding the etiologies of these disorders,TEN is usually caused by drugs while only 50 % of SJS is caused by drugs. In contrast,DRESS is induced by specific drug along with cofactors,viral infections. Long term administration of high dose glucocorticoids is a major contributor to the development of complications and sequelae in SCAR. Other than the drug reactions itself,inappropriate use of glucocorticoids is also the major cause of fatality. In this article,author will further elaborate his approaches dealing with these three different types of SCAR,including therapeutic regimens,main concerns,prevention of complications and sequelae,as well as the approaches to reduce the mortality rates. Post-DRESS autoimmune disorders and their pathogenesis will also be introduced.