精品多形性红斑课件

多形性红斑 Erythema Multiforme 概 述 多形性红斑（Erythema Multiforme）是以 皮肤粘膜多形性损害为特征，严重时伴 有内脏损伤的急性皮肤炎症。 好法发于春秋季 女性多见 发病年龄多为青少年 一、病因学 1、感染：单纯疱疹病毒、支原体感染最 常见，细菌、真菌感染也可引起。 2、药物：磺胺、青霉素、巴比妥类的药 物，以及血清等 3、其它：某些系统性疾病，如LE、DM 、内脏恶性肿瘤 二、临床表现 （一）一般情况： 儿童、青少年多见，春秋季易发病， 皮损发生较快。 （二）全身症状： 畏寒、乏力、发热及关节疼痛，咽喉痛 （三）临床分型： 1、红斑-丘疹型： 皮损特点：淡红斑或水肿性红斑，中 央暗红色或紫色，出现丘疱疹或水疱， 呈虹膜状或靶形。皮疹消退后留下色沉 。 分布：四肢远端，手足背部 全身症状轻、口腔黏膜损伤小 2、水疱-大疱型： 皮损特点：在水肿性红斑基础上，形成水疱、大疱 或血疱，呈虹膜状 有口鼻及生殖器黏膜的损害。 有乏力、关节痛、发热等全身症状。 3、重症型：即Steven-Johnson Syntrome 皮损特点：广泛水肿红斑基础上，出现水疱、大疱 、血疱，尼氏征阳性。 眼、鼻、口、外阴、肛门等部位黏膜糜烂，呼吸道 、消化道黏膜坏死、出血。 全身症状重，可以有肾脏和肝脏的损伤 三、诊断与鉴别诊断 （一）诊断： 1、好发于儿童及青少年，春秋多见 2、皮损多形，好发于四肢远端，虹膜膜样损 害。 3、前驱症状、黏膜损害，全身症状。 （二）鉴别诊断： 大疱性类天疱疮、冻疮。 四、治疗 （一）全身治疗： 1、皮质类固醇激素： 主要用于水疱-大疱型和重症型，给 予甲基强的松龙或地塞米松静脉点滴。 2、抗组胺药物或钙剂的使用： 3、对症治疗，重症者注意调节水盐电解 质平衡。 （二）局部治疗： 原则：消炎、收敛、止痒、预防感 染 1、清洁 2、湿敷 3、抗菌 4、保护 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