DRUG‐INDUCED “INTERTRIGO”
DRUG‐INDUCED “INTERTRIGO”
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药物引起的“摩擦”
DOI：
10.1111/j.1365-4362.1993.tb02837.x
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发表时间：
1993
影响因子：
3.6
通讯作者：
S. Brenner
中科院分区：
文献类型：
--
作者：
R. Wolf;Monika Elman;S. Brenner
一位28岁的女性被收住到我们的皮肤科门诊临床评估一个持续4个月的糜烂性皮疹在intertriginous地区。当她住院治疗流产热时，皮疹就开始了。她有一对双胞胎的自然流产和流产后脓毒性发热。住院期间，患者接受克林霉素、硫酸庆大霉素和头孢唑林治疗。然后改为多西环素和甲硝唑，她继续接受了几个星期。患者的病情在其他地方被诊断为擦烂念珠菌，尽管KOH显微镜检查和沙氏琼脂培养均为阴性，但她正在接受含硝酸异康唑10 mg和戊酸二氟可托龙1/mg/G的乳膏治疗，以及含曲安奈德1 mg、制霉菌素100，000单位、新霉素碱2.5 mg和短杆菌肽的乳膏治疗。然而，火山爆发不仅没有反应，甚至变得更糟，发炎和侵蚀。这种皮肤病对各种其他局部治疗（包括抗真菌和甾体软膏）均无反应。我们的初步检查发现腹股沟、臀间腋窝和乳房下区域有对称性的肿胀性水肿糜烂斑块。用KOH和各种培养基上的培养物进行的重复显微镜检查均为阴性。用欧洲接触性皮肤病研究小组的标准接触性致敏剂电池进行的斑贴试验检查显示出“愤怒的背部综合征”;即使在3天后，所有的试验都是阳性的。鉴于斑贴试验结果，怀疑局部用药的不良反应，指导患者停用所有药物和局部用药。然而，皮疹在3周内没有改善。病变的活检标本显示表皮角化过度、颗粒层增生和棘层增生伴网脊延长。真皮乳头延长、水肿，毛细血管扩张、充血，周围有轻度慢性炎症细胞。由于通常和适当的治疗擦烂未能缓解皮肤状况，皮疹的可能性，以病人的药物之一被认为是。她被指示停止使用甲硝唑，这是她当时服用的唯一药物。铸件的二种
A 28-year-old woman was admitted to our dermatoiogic outpatient clinical for evaluation of an erythematous erosive rash of 4 months duration in the intertriginous areas. The eruption had begun while she was hospitalized for the treatment of abortion fever. She had a spontaneous abortion of twins and developed postabortion septic fever. Her treatment included clindamycin, gentamicin sulfate, and cefazolin during hospitalization. It was then changed to doxycycline and metronidazole, which she continued to receive for several weeks. The patient's condition had been diagnosed elsewhere as Candida intertrigo, and although the microscopic examination with KOH and cultures on Sabouraud's agar were negative, she was being treated with cream containing isoconazole nitrate 10 mg and diflucortolone valerate 1/mg/G, and with a cream containing triamcinolone acetonide 1 mg, nystatine 100,000 units, neomycin base 2.5 mg and gramicidin. The eruption, however, not only failed to respond, but even got worse, inflamed and erosive. The skin condition failed to respond to various other topical treatments including antifungal and steroidal ointments. Our initial examination revealed symmetrical erythematous edematous erosive plaques in the inguinal, intergluteal axillar, and inframammary areas. Repeated microscopic examination with KOH and cultures on various culture media were negative. A patch test examination with the European Contact Dermatitis Research Group's standard battery of contact sensitizers showed an "angry back syndrome"; all the tests were positive even after 3 days. In view of the patch test results an adverse reaction to topical medications was suspected, and the patient was instructed to discontinue all medications and topical applications. The eruption, however, did not improve within 3 weeks. A biopsy specimen from a lesion showed hyperkeratosis, hypergranulosis, and acanthosis of the epidermis with elongation of the rete ridges. The dermis showed elongated and edematous papillae, enlarged and congested capillaries surrounded by mild chronic inflammatory cells. Since the usual and appropriate treatment for intertrigo failed to alleviate the skin condition, the possibility of an eruption to one of the patient's drugs was considered. She was instructed to discontinue the use of metronidazole, the only drug she had been taking at that time. In addition, two