氢氯噻嗪、胺碘酮、环丙沙星、萘普生等可引发光敏性反应,造成皮肤损伤

2019-07-21 岱西 中国循环杂志

晒晒太阳是好事,但有时候就会发生严重晒伤,皮肤出现灼热和瘙痒感、发红、肿胀及起疱等。这里值得注意的是,也许是因为服用的某种药物让你对阳光更敏感。

晒晒太阳是好事,但有时候就会发生严重晒伤,皮肤出现灼热和瘙痒感、发红、肿胀及起疱等。这里值得注意的是,也许是因为服用的某种药物让你对阳光更敏感。

而这些药物所引发的光敏反应,很多会被掩盖,被误诊或根本没有被报道。

建议在服用一下这些药物时,尤其注意防晒,比如涂上防晒霜:

胺碘酮

是光敏药物研究最多的药物,其中服药的患者中少则14%,多则50%以上报道过引发光敏反应,通常表现为阳光下暴露皮肤发红,及灼烧和刺痛感。

约1%~2%的患者受损皮肤会出现明显的蓝灰色色素沉着,特别是在长期服药并暴露阳光后。光敏性通常在停药后几个月内消退,而色素沉着的消退需1~2年。

氢氯噻嗪

与其他噻嗪类利尿剂相比,氢氯噻嗪与多种光敏反应有关,包括晒伤、皮炎和苔藓样皮疹。

而且在某些情况下,慢性湿疹可能会在停药后持续数月至数年。不过,是可治疗的,曾有报道,使用补骨脂素与UVA辐射(PUVA疗法)联合治愈这种湿疹。

环丙沙星

环丙沙星与其他氟喹诺酮类抗生素一样会引起光敏反应,轻则出现晒伤样发红或炎症反应,重则出现疼痛性水疱或脱皮。

甚至还有环丙沙星引发光敏反应致紫癜的病例报道。此外,囊性纤维化患者对药物有特定的光敏性。

强力霉素

四环素类是另一类引发光敏性皮肤反应的抗生素,其中以强力霉素为着。而且剂量越高,反应越强,比如100 mg,150 mg和200 mg的强力霉素引发光敏反应率为3%、20%和42%。

其中典型表现为皮肤灼烧感和发红,症状通常在停药后10~14天内消退。罕见表现为光感性指甲改变,比如甲剥离。

氯丙嗪

服用氯丙嗪的患者可能会出现明显的晒伤反应,有时会出现水疱和苔藓样皮疹。长期大剂量服用氯丙嗪,可导致阳光暴露的皮肤出现灰白色至紫色色素沉着。

值得注意的是,肠外给予还会在接触的护士中引起了光敏性皮炎。

异维A酸

异维A酸具有“光毒性潜力”,缺乏相关临床或实验证据。

萘普生

在最常见的非甾体类抗炎药(NSAIDs)中,萘普生似乎具有最多的光敏反应,通常表现为假卟啉症。

威罗菲尼

威罗菲尼是一种激酶抑制剂,适用于有不可切除或转移黑色素瘤。但这种药可引发轻度至重度光敏反应,包括皮肤灼烧感、发红和肿胀。

伏立康唑

伏立康唑是一种三唑类抗真菌,引起的光敏反应,偶尔会表现为唇炎或假卟啉症。

免疫功能低下的患者中,长期预防性应用伏立康唑,特别是慢性肉芽肿病和器官移植患者,已报道了多例光敏性病例。

值得注意的是,这种药物引起的光敏反应可在开始治疗后数月出现。有研究报道5例同种异体造血细胞移植受者因此误诊为慢性移植物抗宿主病;还有研究发现光敏反应发生的皮肤区域出现老化以及鳞状细胞癌和黑色素瘤。

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    2019-10-30 fangcong
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  5. 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  6. 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  7. 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  8. 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    2019-07-23 yibei

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