文献简介

出版社:

作  者:Marcella Aquino & Greg Rosner

编  号:

关键字:Systemic contact dermatitis;Baboon syndrome

年  份:2018   点击量:150

文献摘要 全文翻译

Systemic contact dermatitis (SCD) traditionally refers to a skin condition where an individual who is cutaneously sensitized to an allergen will subsequently react to that same allergen or a cross reacting allergen via a different route. It occurs to allergens including metals, medications, and foods. The exact pathophysiology underlying this disease remains unknown, although it appears to be mediated by type 4 hypersensitivity reactions and possibly type 3 hypersensitivity reactions. The p-I concept (pharmacologic interaction with immunoreceptors) hypothesized that drugs are able to bind directly to a T cell receptor without first being presented by MHC (major histocompatibility complex) molecules and without prior metabolism, which would help explain why SCD can be seen on first exposure to medications. Nomenclature remains a challenge as SCD can be subcategorized using terms such as ACDS (allergic contact dermatitis syndrome) and its four clinical stages, Baboon syndrome, and SDRIFE (symmetrical drug-related intertriginous and flexural exanthema), which share many overlapping features. Food allergens may be responsible for uncontrolled or persistent symptoms in patients with contact dermatitis who do not respond to topical avoidance. With medications, symptoms may be induced by topical application versus systemic administration. Patch testing (PT) may be beneficial in diagnosing SCD caused by metals and many topical medications including corticosteroids, antimicrobials (ampicillin, bacitracin, erythromycin, neomycin, nystatin), NSAIDs (diclofenac, ibuprofen), anesthetics, and antihistamines (chlorphenamine, piperazine). Current treatment options include topical steroids and oral antihistamines for symptom relief and dietary avoidance to causative foods or metals.

系统性接触性皮炎(SCD)常指已致敏个体通过不同途径再次接触相同过敏原和交叉反应过敏原所致的一种皮肤病。该病发生的过敏原包括金属、药物和食物。尚不清楚该疾病的确切病理生理机制,尽管其似乎是由4型变态反应和3型变态反应介导。P-I概念(药物与免疫细胞受体的药理学作用)假设药物能够直接与T细胞受体结合,而无需与MHC(主要组织相容性复合物)分子结合呈递给T细胞,这有助于解释为什么在首次接触药物时可出现SCD。SCD的命名仍然具有挑战,因为其可以细分为诸如ACDS(过敏性接触性皮炎综合征)及其四个临床阶段,狒狒综合征和SDRIFE(对称性药物相关性见擦部及屈侧疹)等,它们具有许多重叠特征。食物过敏原可能导致接触性皮炎患者出现无法控制或持续的症状,而这些患者对局部过敏反应不明显。使用药物时,局部应用与全身给药可能会诱发症状。贴片试验(PT)可能有助于诊断由金属和许多局部药物引起的SCD,包括皮质类固醇、抗菌药物(氨苄西林、杆菌毒素、红霉素、新霉素、制霉菌素)、非甾体抗炎药(双氯芬酸、布洛芬)、麻醉药和抗组胺药(氯苯那敏、哌嗪)。目前的治疗方案包括局部类固醇和口服抗组胺药以缓解症状,且避免食用引起疾病的食物或金属。