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題 名 | 乾癬病人服用Methotrexate引起皮膚毒性=Methotrexate-Induced Cutaneous Toxicity in a Psoriasis Patient |
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作 者 | 楊倩宜; 鄭吉元; 陳琦華; | 書刊名 | 藥學雜誌 |
卷 期 | 29:3=116 2013.09[民102.09] |
頁 次 | 頁101-105 |
分類號 | 418.2 |
關鍵詞 | 乾癬; 皮膚毒性反應; Methotrexate; Calcium folinate; |
語 文 | 中文(Chinese) |
中文摘要 | 本文為一乾癬病人使用 methotrexate 引起皮膚毒性反應的案例報告。Methotrexate可能引起罕見的皮膚毒性反應,大多發生於乾癬患者,其機轉可能為快速增生的患部細胞較易攝入 methotrexate,而較正常細胞易造成毒性。通常發生於開始治療後的3至7天內,症狀包括皮膚燒灼感、剝離壞死,有如蛇蛻皮一般。皮膚毒性反應可能為嚴重血液毒性的前哨兵,因此應盡早於24小時內給予解毒劑 calcium folinate。Methotrexate 引起皮膚毒性反應的危險因子包括老年人、較高或增加 methotrexate 劑量、感染、腎功能不全及併用危險藥品,如非類固醇消炎止痛藥 (nonsteroidal antiinflammatory drugs,NSAIDs) 及 trimethoprim-sulfamethoxazole (TMP-SMX) 等。對於高危險群患者,建議使用較低的 methotrexate 起始劑量,並依臨床治療需要緩慢增加劑量,同時小心監測患者是否發生相關的不良反應。 |
英文摘要 | We reported a patient with psoriasis who developed methotrexate-induced cutaneous toxicity. Methotrexate can cause rare cutaneous toxicity most commonly in patients with psoriasis. It has been hypothesized that these hyperproliferative epidermal cells of psoriatic plaques take up more of the methotrexate than normal cells and are thus more susceptible to its toxic effects. The symptoms include burning sensation and sloughing of the skin and usually appeared between 3 and 7 days after exposure. The cutaneous toxicity may serve as a herald for the impending development of life-threatening pancytopenia, hence, the antidote "calcium folinate" should be administered within 24 hours. Predisposing factors for methotrexate induced cutaneous toxicity include older age, higher or increased methotrexate dose, infection, renal dysfunction and concomitant use of nonsteroidal antiinflammatory drugs or trimethoprim-sulfamethoxazole. For these high risk patients, it is suggested to start with lower initial dose of methotrexate and adjust gradually according to clinical response. Meanwhile, we should carefully monitor whether the adverse drug reactions related to methotrexate was occurred. |
本系統中英文摘要資訊取自各篇刊載內容。