重症多形性红斑的诊治分析

目的探讨重症多形性红斑的临床诊治特点。方法回顾性收集20例重症多形性红斑患者的临床资料,分析重症多形性红斑的临床特点、可疑致敏药物、治疗方法以及治愈时间。结果20例患者均给予立即停用可疑致敏药物、环境隔离等基础治疗,早期足量应用皮质类固醇激素治疗,并联合抗组胺药物口服。1例患者常规剂量皮质类固醇激素治疗效果欠佳,且因为害怕激素副作用拒绝增加激素剂量,予以阿达木单抗40 mg皮下注射,2天后红斑明显消褪。经积极治疗后,20例患者均疾愈,未见明显并发症,各项实验室检查指标基本恢复正常。12例患者存在可疑致敏药物,包括抗抑郁、癫痫药物(2例),中成药(1例),解热镇痛药(1例),抗生素(7例),化疗药物(1例),其它可疑致敏因素(3例)。结论重症多形性红斑首选治疗药物是皮质类固醇激素,同时强调基础治疗。阿达木单抗可作为激素控制不佳时的替代治疗方案。

Objective To investigate the clinical characteristics of severe erythema multiforme.Methods Clinical data of 20 patients with severe erythema multifomie were retrospectively collected to analyze the clinical characteristics.suspected sensitizing drugs,treatment methods and cure time of severe erythema multiforme.Results All 20 patients received basic treatment such as immediate discontinuation of suspected sensitizing drugs and environmental isolation,early adequate treatment with corticosteroids,and oral administration combined with antihistamines.One patient was not effective in conventional corticosteroid therapy,and refused to increase the dose of corticosteroid for fear of hormone side effects.After subcutaneous injection of 40 mg adalimumab,the erythema were decreased significantly 2 days later.After active treatment,all the 20 patients were cured without obvious complications,and the laboratory test indexes basically returned to normal.Twelve patients had suspected sensitization drugs,including antidepressant and epileptic drugs(2 cases),Chinese patent drugs(1 case),antipyretic analgesics(1 case),antibiotics(7 cases),chemotherapy drugs(1 case),and other suspected sensitization factors(3 cases).Conclusion The preferred treatment for severe erythema multiforme is corticosteroids with emphasis on basic treatment.Adalimumab can be used as an alternative treatment when hormone control is poor.