Duża część reakcji polekowych zaczyna się od zmian skórnych. Jest to istotne, z uwagi na to, iż to właśnie objawy występujące na skórze są pewnego rodzaju ostrzeżeniem przed ciężkimi, niekiedy zagrażającymi życiu reakcjami.
Wśród czynników, które zwiększają ryzyko wystąpienia skórnych reakcji polekowych jest wiek pacjenta, płeć, predyspozycja do atopii, stan immunologiczny, choroby współistniejące. Ważne są również kwestie związane z samym lekiem, takie jak dawka, droga podania, liczba leków, ich interakcje oraz metabolizm leku. Wpływ na potencjalne reakcje mają również czynniki genetyczne.
Do najczęstszych reakcji polekowych zalicza się osutki plamiste i plamisto-grudkowe (40%), pokrzywkę i obrzęk naczynioruchowy (37%) oraz zlokalizowane odczyny skórne (6%).
Lekami, które wywołują osutkę plamisto-grudkową są ampicylina, amoksycylina, aminoglikozydy, allopurynol, barbiturany, benzodiazepiny, karbamazepina, kotrymoksazol, sole złota, penicylina, fenytoina i piroksykam. U pacjentów z alergicznym kontaktowym zapaleniem skóry na substancje miejscowe, takie jak leki przeciwhistaminowe może wystąpić reakcja w postaci rozległej wysypki rumieniowej lub pokrzywkowatej, którą określa się jako krwiopochodne kontaktowe zapalenie skóry. W poważniejszych przypadkach, mogą pojawić się również intensywne rumienie w okolicach zgięciowych i płciowych, zwane zespołem pawiana.
Pokrzywkę najczęściej wywołują takie leki, jak penicylina i pochodne, antybiotyki, aspiryna, kaptopryl, lewamisol, NLPZ, sulfonamidy, insulina i radiologiczne środki cieniujące.
Obrzęk naczynioruchowy natomiast wywołują inhibitory ACE.
Przyczyną pojawienia się zlokalizowanych zmian skórnych jest ampicylina, aspiryna, barbiturany, dapson, metronidazol, NLPZ, doustne środki antykoncepcyjne, fenyloftaleina, fenytoina, chinina, sulfonamidy i tetracykliny. Zmiany te pojawiają się ponownie na skutek powtórnej ekspozycji na lek, a wyglądem przypominają typowo czerwonobrunatną plamę lub blaszkę, niekiedy również pęcherz. Występują najczęściej w okolicach płciowych, na dłoniach, stopach, jak również błonie śluzowej. Wykwity mierzą zazwyczaj 5-10 cm. Mogą być jednak większa, a nawet mnogie.
Źródło: Sterry W., Paus R., Burgdorf W., Dermatologia, Wydawnictwo Czelej, Wydanie pierwsze polskie Lublin 2009
Przeczytaj także: Lawaseptyka, antyseptyka i aseptyka – dlaczego są ważne w leczeniu ran?
Przeczytaj bezpłatnie pokrewny artykuł w czasopiśmie „Pielęgniarstwo w Anestezjologii i Intensywnej Opiece”:
Pacjent bariatryczny w oddziale intensywnej terapii – opis przypadku
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