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中华临床医师杂志(电子版) ›› 2024, Vol. 18 ›› Issue (03) : 328 -332. doi: 10.3877/cma.j.issn.1674-0785.2024.03.016

病例报告

滥用外用药物所致重度大面积皮肤溃疡伴全身炎症反应综合征一例
赵喜迎1, 吴贝贝1, 叶敬成1, 孙炳伟2, 谢尔凡1,()   
  1. 1. 215010 苏州,南京医科大学附属明基医院苏州院区烧伤与创面修复科
    2. 215008 苏州,南京医科大学附属苏州医院烧伤整形科
  • 收稿日期:2023-12-01 出版日期:2024-03-15
  • 通信作者: 谢尔凡

Severe large area skin ulcer with systemic inflammatory response syndrome caused by misuse of topical medications: a case report

Xiying Zhao1, Beibei Wu1, Jingcheng Ye1, Bingwei Sun2, Erfan Xie1,()   

  1. 1. Department of Burn and Wound Repair, Suzhou BenQ Medical Center, The Affiliated BenQ Hospital of Nanjing Medical University, Suzhou 215010, China
    2. Department of Burn and Plastic Surgery, The Affiliated Suzhou Hospital of Nanjing Medical University, Suzhou 215008, China
  • Received:2023-12-01 Published:2024-03-15
  • Corresponding author: Erfan Xie
引用本文:

赵喜迎, 吴贝贝, 叶敬成, 孙炳伟, 谢尔凡. 滥用外用药物所致重度大面积皮肤溃疡伴全身炎症反应综合征一例[J]. 中华临床医师杂志(电子版), 2024, 18(03): 328-332.

Xiying Zhao, Beibei Wu, Jingcheng Ye, Bingwei Sun, Erfan Xie. Severe large area skin ulcer with systemic inflammatory response syndrome caused by misuse of topical medications: a case report[J]. Chinese Journal of Clinicians(Electronic Edition), 2024, 18(03): 328-332.

本文报道一例中年女性患者,因反复皮疹6月余,自行使用多种外用药物治疗,或单用、或混用,致使皮损进行性加重,大面积皮肤破溃伴感染,创面呈侵袭性,并引发全身炎症反应,皮损总面积约30% TBSA。入院主要诊断:重度大面积皮肤溃疡伴全身炎症反应综合征。入院后,行多学科会诊(multi-disciplinary treatment,MDT),完善免疫学及相关炎症指标等检查,排除自身免疫性及免疫缺陷疾病,予以全身综合性治疗、创面个性化序贯治疗、全程分阶段的精准心理干预等。住院1月余,患者创面愈合,痊愈出院。本文对发病原因、全身与局部治疗、机体与心理治疗、重视免疫系统功能评估、加强OTC药物销售管理与使用宣教等相关问题进行了讨论。

This paper reports the case of a middle-aged female patient who used a variety of topical medications alone or in combination because of repeated rashes for more than 6 months, which resulted in progressive aggravation of skin lesions, extensive skin ulceration with infection, invasive wound surface, and systemic inflammatory reaction. The lesions involved 30% of total body surface area. The main diagnosis at admission was severe large area skin ulcer with systemic inflammatory response syndrome. After admission, multi-disciplinary consultation was performed, related immunologic and inflammatory indicators were detected, autoimmune and immunodeficiency diseases were excluded, and systemic comprehensive treatment, personalized sequential treatment of wounds, and precise psychological intervention in stages were applied. After being hospitalized for more than one month, the patient recovered and was discharged. This paper discusses the causes of the disease, systemic and local treatment, and physical and psychological therapy, highlighting the evaluation of immune system function, management of OTC drug sales, and medication use education.

图1 入院时创面情况。图a为双下肢正侧面;图b为双下肢背侧及臀部;图c为下腹部及会阴处
图2 出院时创面愈合情况。图a为患者臀部;图b为右下肢前侧;图c为左下肢前侧;图d为右下肢背侧;图e为左下肢背侧
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