RECURRENT AND CHRONIC LEG ULCERS SECONDARY TO FUROSEMIDE‐INDUCED BULLOUS PEMPHIGOID
RECURRENT AND CHRONIC LEG ULCERS SECONDARY TO FUROSEMIDE‐INDUCED BULLOUS PEMPHIGOID
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呋塞米诱发的大疱性类天疱疮继发的复发性和慢性腿部溃疡
DOI：
10.1111/j.1532-5415.1995.tb07038.x
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发表时间：
1995
影响因子：
6.3
通讯作者：
M. Zaman
中科院分区：
文献类型：
--
作者：
M. Siddiqui;M. Zaman
编辑：速尿通常用于治疗充血性心力衰竭、高血压和慢性肾功能衰竭。速尿是一种磺胺类衍生物，磺胺类药物引起的皮疹是公认的。速尿的不良皮肤学反应包括大疱性表皮松解症、出血性大疱性皮疹、2例多形性红斑。3皮管炎、光反应和大疱性类天疱疮。我们报告三例复发性和慢性小腿溃疡，继发于可能由速尿引起的大疱性类天疱疮。在所有的病例中，都获得了组织病理学的证实，速尿变成了布美他尼或乙丙奈酸。患者的详细情况如表1所示。低剂量速尿或大剂量治疗可引起大疱性皮损，如慢性肾功能衰竭患者所见--继发于速尿诱导的大疱性皮疹--可能出现在正常皮肤或大疱性皮损之前的斑丘疹上--“或先前的全身性瘙痒。”这些水泡通常出现在四肢，但也可能出现在躯干、面部或耳朵上(表2)。有大疱性皮损的速尿的持续时间可能长达4至8周。最少报告的时间是6天？起泡的病变可能是清楚的，底部有红斑，或者坦率地说是出血。Heydenreich等人报道称，在56名服用大剂量速尿的患者中，有12人出现大疱性皮损的频率最高。大疱性疾病患者的血清速尿水平、组织类型抗原和血型相似，对卟啉水平正常的速尿斑贴或划痕试验的反应相似。这些皮损要么对症治疗，要么用大剂量皮质类固醇治疗。关于大疱性皮疹的发病机制存在争议，一些工作人员认为这些皮疹
To the Editor: Furosemide is prescribed commonly in congestive cardiac failure, hypertension, and chronic renal failure. Furosemide is a sulfonamide derivative, and skin eruptions with sulfonamides are well recognized. Adverse dermatological reactions to furosemide include epidermolysis bullosa,'hemorrhagic bullous eruptions, 2 erythema multiforme,. 3 vas~ ulitis,~ photoreaction,'and bullous pemphigoid.'We report three cases with recurrent and chronic leg ulcers, secondary to possible furosemide-inducing bullous pemphigoid. In all cases, histopathological confirmation was obtained and furosemide changed to bumetanide or ethacrynic acid. The patient details are tabulated in Table 1. Furosemide may cause bullous lesions with low-dose7 or high-dose therapy as seen in patients with chronic renal fail-SECONDARY TO FUROSEMIDE-INDUCED BULLOUS They may appear on normal skin or on a maculopapular rash preceding the bullous lesions-" or with preceding generalized pruritus.'These blisters usually appear on the extremities but may appear on trunk, face, or ears (Table 2). The duration of furosemide with bullous lesions may be long-term',', 4 to 8 weeks'. 5; the least time reported has been 6 days? The blistering lesions may be clear, with erythematous base,'or frankly hemorrhagic. 2*'They may be seasonal, seen during the summer,'or unrelated to any season.'Heydenreich et al.'reported the highest frequency of bullous lesions in 12 of 56 patients prescribed high dose furosemide therapy. The cases with bullous disease had comparable serum furosemide levels, tissue-type antigen, and blood group, and similar responses to furosemide patch or scratch test with normal porphyrin levels. The lesions were treated either symptomatically or with high dose corticosteroids.'There is controversy about the pathogenesis of the bullous eruptions, and some workers believe that these eruptions