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7/24/2019 Resumo sobre Farmacodermias
http://slidepdf.com/reader/full/resumo-sobre-farmacodermias 1/9
RESUMO DE SEMIOLOGIA DERMATOLÓGICA – FARMACODERMIAS
Profº Edilbert Pellegrini 1!11!"#1$
FARMACODERMIAS% REA&'ES CUT()EAS AD*ERSAS A MEDICAME)TOS
Con+eito,
E-ide.iologi/
Cl/,,ifi+/0o
Me+/ni,.o,
For./, Le2e,
For./, Gr/2e,
Di/gn3,ti+o
Tr/t/.ento
CO)CEITOS%
1! Drog/%
Drog/ 4 tod/ ,5b,t6n+i/ 758.i+/ 9o5 +o.bin/0o del/,: /d.ini,tr/d/, -/r/ /
in2e,tig/0o; -re2en0o e<o5 tr/t/.ento e. ,it5/0=e, de doen0/ o5 de ,into./,; ,e>/.
ele, re/i, o5 i./gin?rio,!
A, 2i/, de /d.ini,tr/0o de drog/, ,o% inge,to; in>e0o; in/l/0o; in,er0o;
in,til/0o o5 /-li+/0o t3-i+/!
"! Re/0o /d2er,/ @ Drog/%
Con,i,te e. tod/ re,-o,t/ no+i2/ o5 inde,e>?2el /o, .edi+/.ento,; o+orrendo
n/, do,e, 5tili/d/, -/r/ -rofil/Bi/; di/gn3,ti+o e<o5 tr/t/.ento de doen0/,; o5 /ind/
-/r/ .odifi+/0=e, de 5./ f5n0o fi,iol3gi+/!
tod/ +on,e75n+i/ no ter/-5ti+/ do 5,o de 5./ drog/; @ eB+e0o de /b5,o;
en2enen/.ento e f/ln+i/ ter/-5ti+/!
5/l75er drog/ -ode +/5,/r 75/l75er ti-o de re/0o
! F/r./+oder.i/
So re/0=e, teg5.ent/re, 9-ele e<o5 .5+o,/,:; +o. o5 ,e. ./nife,t/0=e,
,i,t.i+/, 9nor./l.ente rin,; -5l.=e,; f8g/do e 3rgo, He./to-oi4ti+o,:; -rod5id/,diret/ o5 indiret/.ente -or 5./ drog/!
7/24/2019 Resumo sobre Farmacodermias
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EPIDEMIOLOGIA
$ / #J do, doente, Ho,-it/li/do, e2ol5e. +o. f/r./+oder.i/, e.
+on,e75n+i/ do tr/t/.ento in,tit58do; ,endo "J de,,/, re/0=e, +on,ider/d/, gr/2e, e
#;1 / #;J f/t/i,!
Prin+i-/i, drog/,% -eni+ilin/;,5lfon/.id/,; /ntiinfl/./t3rio, no e,teroide, e
/nti+on25l,i2/nte,!
In+idn+i/ /5.ent/ +o. /d.ini,tr/0o ,i.5lt6ne/ de drog/,!
Re/0=e, +5t6ne/, e. ";KJ do, +/,o,! EB/nte./ .?+5lo-/-5l/r 5rti+?ri/
2/,+5lite!
M5lHere, o.en,
Ido,o, Cri/n0/,
Aten0o -/r/ neon/to,; .et/boli/dore, lento,; -/+iente, +o. in,5fi+in+i/
He-?ti+/; Hi-otireoidi,.o; in,5fi+in+i/ ren/l +rNni+/!
Ad.ini,tr/0o% EPI ID SC IM ORAL E*
D5r/0o do tr/t/.ento 4 5. f/tor -redi,-onente!
CLASSIFICA&O DE EFEITOS AD*ERSOS COM USOS DE DROGAS 9LA)CET;
"###:
Tipo A: Re/0=e, t3Bi+/,; do,e de-endente,!
EB% Hi-ogli+e.i/ -or Hi-ogli+e.i/nte,; Bero,e 9re,,e+/.ento: -or retin3ide,
9.edi+/.ento, 75e in+enti2/. / de,+/./0o d/ -ele e red50o d/ oleo,id/de:!
Tipo B: Re/0=e, idio,,in+r?,i+/, 9-e,,o/i,; -e+5li/re,: 75e no .o,tr/. rel/0o do,e
de-endente e /-re,ent/. 2/ri/0o indi2id5/l%
1% Re/0=e, /l4rgi+/, i.edi/t/,; t/rdi/, e ret/rd/d/,! EB! 5rti+?ri/; /n/fil/Bi/ eeB/nte./,!
"% Re/0=e, de foto,,en,ibilid/de!
% Doen0/, /5toi.5ne,!
Q% Re/0=e, -,e5do/l4rgi+/,!
Tipo C: M/nife,t/0=e, t/rdi/, de+orrente, d/ re,-o,t/ f/r./+ol3gi+/ /lter/d/; re,5lt/nte
de 5./ eB-o,i0o ./ntid/ @ drog/ e<o5 -rogre,,o d/ doen0/!EB% S8ndro.e de C5,Hing; e-/totoBi+id/de -or -/r/+et/.ol
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Tipo D: Efeito, t/rdio, +o.o +/r+inogne,e o5 ter/togni+id/de!
EB% Ter/togni+id/de -or retin3ide, e t/lido./; t5.ore, e-iteli/i, -or +i+lo,-orin/!
Tipo E: Sobre+/rg/ d/ drog/ -or ,5-erdo,/ge. o5 /+.5lo eB+e,,i2o; ,e>/ d/ -r3-ri/
drog/ o5 de /lg5. .et/b3lito deri2/do d/ .e,./!
EB% in,5fi+in+i/ /dren/l -or +orti+oide,; e-ile-,i/ -or ,5,-en,o de /nti+on25l,i2/nte,!
Tipo F: F/ln+i/ ter/-5ti+/ ine,-er/d/! EB% f/lH/ de /nti+on+e-+ion/i,
MECA)ISMOS
1! I.5nol3gi+o, 9Cl/,,ifi+/0o de Gell e Co.b,:
/: C/r/+ter8,ti+/,% So i.-re2i,82ei, e diferente, d/, /0=e, f/r./+ol3gi+/,
U./ ni+/ drog/ -ode -rod5ir re/0=e, diferente,
Drog/, diferente, -ode. -rod5ir re/0=e, ,e.elH/nte,
Re/0=e, ,e.elH/nte, / 75/dro, /l4rgi+o,
)e+e,,it/ de 5. -er8odo de ,en,ibili/0o! )/ reeB-o,i0o / re/0o 4 i.edi/t/!
)or./l.ente ,o do,einde-endente,
A Hi-er,en,ibilid/de 4 -er,i,tente Pode. o+orrer re/0=e, foto758.i+/, o5 foto/l4rgi+/,
b: Ti-o,
Tipo I: An/fil?ti+/
- Tipo II: Citot3Bi+/
Tipo III: Atr/24, de i.5no+o.-leBo,
Tipo IV: Cel5l/r
"! )o i.5nol3gi+o,%/: C/r/+ter8,ti+/,%
So -re2i,82ei,; do,ede-endente, e nor./l.ente rel/+ion/do, @ /0o
f/r./+ol3gi+/ d/ drog/!
b: EBe.-lo,%
Efeito +ol/ter/l o5 ,e+5nd?rio @ /0o f/r./+ol3gi+/
7/24/2019 Resumo sobre Farmacodermias
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S5-erdo,e 9/0o t3Bi+/:
Intoler6n+i/ o5 idio,,in+r/,i/ 9re>ei0o<re/0o -/rti+5l/r; i,ol/d/:
Alter/0=e, d/ Ho.eo,t/,e
Inter/0=e, .edi+/.ento,/, 9interfern+i/, n/ eB+e0o; inibi0o o5 e,ti.5l/0o
de eni./, de degr/d/0o< +o.-eti0o -elo .e,.o ,8tio -rotei+o:
Liber/0o de Hi,t/.in/
Re/0=e, foto758.i+/,
Alter/0=e, .et/b3li+/,
Ter/togeni+id/de
De,en+/de/.ento o5 eB/+erb/0o de doen0/,%
Re/0o de /ri,+HerBHei.er% re/0o /5toli.it/d/ 75e o+orre /-3, / do,e
ini+i/l do tr/t/.ento /nti.i+robi/no; de+orrente d/ inten,/ li,e +el5l/r b/+teri/n/
deter.in/d/ -el/ .edi+/0o! Entre o, -o,,82ei, /ntibi3ti+o, en2ol2ido,; / -eni+ilin/ 4 /
re,-on,?2el n/ i.en,/ ./iori/ do, +/,o, e o tr/t/.ento de ,8fili, 4 o eBe.-lo -rin+i-/l!
! Me+/ni,.o, Indeter.in/do,%/: C/r/+ter8,ti+/,%
So i.-re2i,82ei,; do,einde-endente,; no rel/+ion/do, +o. /0o
f/r./+ol3gi+/ de -o,,82ei, b/,e, gen4ti+/, o5 de .e+/ni,.o, i.5nol3gi+o,!
b: Ti-o,%
DRESS% Dr5g r/,H itH eo,ino-Hili/ /nd ,,te.i+ ,.-to.,
)e+r3li,e e-id4r.i+/t3Bi+/ 9S8ndro.e de Lell:%
S8ndro.e de Ste2en, oHn,on
L-5, erite./to,o ,i,t.i+o,8.ile
Re/0=e, @ drog/, e. -/+iente, I*V
FORMAS LE*ES
1! Pr5rido% ,en,/0o in+N.od/ n/ -ele o5 .5+o,/, 75e le2/ / +o0/r; de2ido @
liber/0o -elo org/ni,.o de ,5b,t6n+i/, 758.i+/,; e,-! / Hi,t/.in/; 75e irrit/. /lg5.
ner2o -erif4ri+oW +o.i+Ho; +o+eir/!
"! E+e./ de Cont/to% Der./tite de +ont/to o5 e+e./ de +ont/to 4 5./ re/0o
infl/./t3ri/ 75e o+orre de2ido /o +ont/to d/ -ele +o. 5. /gente irrit/ti2o 9e+e./ -or
irrit/nte -ri.?rio: o5 75e +/5,e /lergi/ 9e+e./ /l4rgi+o:!
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E+e./ X /fe+0o /l4rgi+/; /g5d/ o5 +rNni+/; d/ -ele; +/r/+teri/d/ -or re/0o
infl/./t3ri/ +o. for./0o de 2e,8+5l/,; de,en2ol2i.ento de e,+/./, e -r5rido!
! Er5-0o eB/nte.?ti+/% U. eB/nte./ o5 r/,H +5t6neo 4 o /-/re+i.ento de
er5-0=e, +5t6ne/, 2er.elH/, e. 5. regio e,-e+8fi+/ o5 -or todo o +or-o +/5,/d/, -or
infe+0=e, 2ir/i, e<o5 b/+teri/n/,; o5 efeito +ol/ter/l de .edi+/.ento, +o.o /,
-eni+ilin/,!
EB/nte./ di re,-eito @ /lter/0o +/r/+teri/d/ -or 5. erite./ di,,e.in/do no +or-o!
Mo,tr/,e n/75ele, -/+iente, 75e ,e /-re,ent/. +o. bo/ -/rte d/ -ele +obert/
-or ./n+H/, 2er.elH/,; ./, 75e /-re,ent/. regi=e, de +olor/0o nor./l!
Q! Erite./ -ig.ent/r fiBo% ./n+H/ erite./to,/ redond/ o5 o2/l; be.
deli.it/d/; 75e re+idi2/ ,e.-re no .e,.o lo+/l; .e,.o 75e /-/re0/. no2/, le,=e,
,i.5lt/ne/.ente e. o5tr/, ?re/,!
Erite./% ./n+H/ de +olor/0o /2er.elH/d/ -ro2o+/d/ -or 2/,odil/t/0=e, +5t6ne/,;
,e>/ -or 5. -ro+e,,o infe++io,o o5 infl/./t3rio; +/5,/ndo 5. ./ior /-orte de ,/ng5e
n/ regio e /lter/ndo / +olor/0o d/ -ele! / ./nobr/ ,e.iol3gi+/ de d8gito-re,,o f/
+o. 75e o+orr/ o de,/-/re+i.ento do erite./; o 75e 4 i.-ort/nte -/r/ diferen+i/r
o5tr/, le,=e, ele.ent/re, 75e no de,/-/re+e. 975e ,o /, ./n+H/, He.orr?gi+/,:! O
ter.o e./nte./ di re,-eito /o erite./ lo+/li/do e. .5+o,/,!
$! Urti+?ri/% er5-0o +5t6ne/ +/r/+teri/d/ -el/ -re,en0/ de -l/+/, +onge,ti2/,
-o5+o ,/liente, e fre75ente.ente -r5rigino,/,!
Y! Fotoder./to,e, ind5id/, -or drog/% /fe+0=e, d/ -ele /-3, / eB-o,i0o ,ol/r
-ro2o+/d/ -or 5./ ,en,ibilid/de /nor./l.ente ele2/d/ @ l5 de2ido /o 5,o de.edi+/.ento,!
K! Er5-0o li75en3ide% Er5-0o +5t6ne/ ,e.elH/nte /o l875en -l/no ind5id/
-elo 5,o de drog/,!
L875en -l/no% -l/+/+o. /+ent5/0o d/, -reg/, d/ -ele; +o. /+ent5/0o d/, e,tri/, d/
-ele; o 75e re,5lt/ e. 5. 75/dri+5l/do e. rede; +o.o ,e / -ele e,ti2e,,e ,endo 2i,t/
/tr/24, de 5./ l5-/! A regio +ir+5nd/nte torn/,e; e. ger/l; de +or +/,t/nHo e,+5r/!
en+ontr/d/ no, e+e./, li75enifi+/do, o5 e. 75/l75er ?re/ ,5>eit/ / +o0/d5r/,+on,t/nte, 9E+e./, +rNni+o,:
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Z! Er5-0o /+neifor.e% le,=e, /2er.elH/d/, +o. +entro +ontendo ,e+re0o
/./rel/d/!
[! */,+5lite 9+5t6ne/ e<o5 ,i,t.i+/:% -ro+e,,o de infl/./0o 2/,+5l/r
i.5nologi+/.ente .edi/do; 75e deter.in/ d/no f5n+ion/l e e,tr5t5r/l n/ -/rede do,
2/,o,
FORMAS GRA*ES
1! Erite./ .5ltifor.e% le,=e, ero,/d/, 75e 2/ri/. e. n.ero; /,-e+to e for./to,!
Pode. /-re,ent/r le,=e, e. /l2o% -5ntifor.e +o. di2er,o, H/lo, /o ,e5 redor; o5 le,=e, e.
-l/+/, erite./to,/, ,e. ,er e. /l2o!
Al2o t8-i+o X 2e,8+5l/ V " H/lo,!
"! S8ndro.e de Ste2en, oHn,on% /-re,ent/ le,=e, ,e.elH/nte, /o Erite./
M5ltifor.e; +o. .?+5l/, -5r-ri+/, e bolH/, di,,e.in/d/, -elo tron+o e f/+e! Pode.
,5rgir le,=e, e. /l2o /t8-i+o, no dor,o d/, .o,; regi=e, -/l.o-l/nt/re,; f/+e
eBten,or/ d/, eBtre.id/de,; f/+e; regio +er2i+/l e -er8neo! Pode ,er -re+edido -or
eB/nte./ .orbilifor.e! A+o.eti.ento de .5+o,/, 4 +o.5.; -odendo /-re,ent/r
en/nte./; ede./; ero,=e, e -,e5do.e.br/n/,! Pode H/2er for./0o de +ro,t/,
He.?ti+/,; -rin+i-/l.ente n/ bo+/ 9MUITO COMUM:; +on>5nti2ite -5r5lent/ ,e.ne+e,,?ri/ /,,o+i/0o b/+teri/n/!T/.b4. +/5,/ febre; le,=e, no tr/to re,-ir/t3rio e
TGI; ,endo ./i, +o.5. e. -/+iente, I* -o,iti2o,! Tr/t/.ento% ,5,-en,o d/ drog/
75e +/5,/ d/ doen0/; ,5-orte b?,i+o de 2id/ e +orti+oide, 9n/, -ri.eir/, QZH:!
! )e+r3li,e e-id4r.i+/ t3Bi+/% ne,t/, le,=e, / -/rte ,5-erfi+i/l d/ e-ider.e e,t?
ne+ro,/d/ 9-erdendo .5it/ ?g5/ -/r/ o .eio:; o -/+iente -ode entr/r f/+il.ente e.
de,e75il8brio eletrol8ti+o! A -ele -ode e,t/r de,+/./ti2/ +o. f/+ilid/de 975/l75er to75en/, le,=e, -ode +/5,/r de,+/./0o:! ./i, +o.5. e. -/+iente, +o. I* e .5lHere,!
Pode +/5,/r febre; dor de g/rg/nt/; to,,e; 75ei./0o ,ol/r; /+o.eti.ento de .5+o,/,;
orof/ringe; olHo,; genit?li/ e 6n5,; er5-0o erite./to,/ +r6nio +/5d/l +o. 75ei./0o e
dor n/ -ele! E,,e, ,into./, -redo.in/. n/, ?re/ fotoeB-o,t/,! Pode H/2er
+o.-ro.eti.ento de 3rgo, interno, i.-ort/nte,!
Sin/l de )i\ol,\ -o,iti2o X /o redor d/ le,o; ,e o .4di+o -re,,ion/r n/ -ele nor./l
e de,li/r o dedo; / -ele ir? ,e ,olt/r! Gr/5 de .ort/lid/de de +er+/ de #J! Etiologi/ X5,o de .edi+/.ento,; e drog/,! Tr/t/.ento +o.o 5. gr/nde 75ei./do!
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Q! Erite./ nodo,o% +on,i,te n/ -re,en0/ de n3d5lo, doloro,o, -rin+i-/l.ente
n/, -ern/,! )o 4 5ni+/.ente /,,o+i/do / f?r./+o,; ./, t/.b4. @ gr/2ide e doen0/,
infe++io,/, o5 no! Le,=e, ./i, -/l-?2ei, 75e 2i,82ei, 9-ele -or +i./ no /-re,ent/
.5it/, +/r/+ter8,ti+/, – eB+eto le2e erite./! I,,o -or ,er n3d5lo:!
Diferen+i/r de erite./ nodo,o H/n,ni+o X o, " ,o idnti+o,; ./, o H/n,ni+o -ode
/+onte+er e. 75/l75er -/rte do +or-o e e,te o+orre /-en/, n/, -ern/,!
$! Eritroder.i/ e,foli/ti2/% 75/ndo ,e f/l/ de eritroder.i/ refere,e / erite./,
-re,ente, no +or-o todo! Pode -redo.in/r o erite./ o5 / de,+/./0o; o5 /ind/ /.bo,!
Y! P5,t5lo,e eB/nte.?ti+/ gener/li/d/ /g5d/ 9PEGA:% .i+ro -,t5l/, .5ito
,5-erfi+i/i, ,obre 5./ -ele erite./to,/! Di/gn3,ti+o diferen+i/l +o. -,or8/,e -5,t5lo,/
gener/li/d/! C/5,/do -or /ntibi3ti+o,; -/r/+et/.ol; itr/+on/ol; -odendo o+orrer +o.
febre e le5+o+it?rio! /5toli.it/d/; tendendo / de,/-/re+er +o. / retir/d/ do
.edi+/.ento!
K! DRESS 9Re/0o / drog/ +o. eo,inofili/ e ,into./, ,i,t.i+o, – ,8ndro.e de
Hi-er,en,ibilid/de:%
Crit4rio, di/gn3,ti+o,% eo,inofili/ o5 linfo+ito,e /g5d/; er5-0o +5t6ne/
rel/+ion/d/ @ drog/ 9nor./l.ente eB/nte./ ./+5lo-/-5l/r:; en2ol2i.ento ,i,t.i+o!
A, ./nife,t/0=e, +l8ni+/, -ode. ,5rgir /t4 " .e,e, /-3, o in8+io do f?r./+o –
etiologi/ -or drog/ ,5be,ti./d/! Pode ,er erite./ 2iol?+eo de,+/./ti2o!
M/nife,t/0=e, 2ir/i, -ode. f/+ilit/r / re/0o /d2er,/ @ drog/!
OUTROS1! Iododer./ e bro.oder./"! E,tri/, -or +orti+oide% .5ito +o.5n, n/ f/+e .edi/l d/, +oB/, 9-rin+i-/l.ente
e. .5lHere,:; no /bdo.e e n/ regio e,tern/l! O+orre. t/nto -or 5,o ,i,t.i+o
75/nto t3-i+o!! Atrofi/ -or +orti+oide 9in>e0o de +orti+oide -or de-3,ito:% -l/+/ de /trofi/ no
lo+/l d/ in>e0o!Q! Alo-4+i/% 75i.ioter?-i+o,; /nti+on+e-+ion/i,!
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$! i-ertri+o,e% MinoBidl -ri.eiro er/ 5,/do +o.o /ntiHi-erten,i2o; ./,
-er+ebe5,e 75e 4 +/-/ de /5.ent/r o, -elo, 75/ndo /-li+/do lo+/l.ente!
Cont5do; -ode /5.ent/r -elo, / di,t6n+i/!Y! I+tio,e% glof/,e.in/ 975i.ioter?-i+o -/r/ H/n,en8/,e: +/5,/ re,,e+/.ento
K! L-5, erite./to,o ,8.ile% o +o.-le.ento e,t? nor./l 9no 4 +on,5.ido:; no,o en+ontr/do, /nti+or-o, /ntiD)A -r3-rio; ./, ,i. /nti+or-o, /ntiHi,ton/,
9[#J do, +/,o,:! A for./ +l8ni+/ 4 ./i, br/nd/; no /+o.ete rin, e S)C! Pode
,er +/5,/do -or /nti+on25l,i2/nte,!Z! Di,+ro.i/% -re,en0/ de ?re/, Hi-er o5 Hi-o-ig.ent/d/,! Pode ,er +/5,/d/ -or
/nti/rr8t.i+o 9.i5d/ron/:!
Tetr/+i+lin/ -ode +/5,/r -ig.ent/0o definiti2/ e. dente, de +ri/n0/, .enore, de
[ /no,!
[! Gr/n5lo./ -iogni+o% /nti2ir/i, no tr/t/.ento de I*; gr/2ide!
DIAG)ÓSTICO
1! An/.ne,e +5id/do,/% Rel/0o te.-or/l entre o 5,o de .edi+/.ento, e o in8+io do, ,into./, Ti-o de er5-0o EB+l5,o de o5tr/, +/5,/,
Ob,er2/0o de -o,,82el en2ol2i.ento ,i,t.i+o 9-ode e,t/r /,,o+i/do o5 ,er /
+/5,/ do, ,into./,:% glo.er5lonefrite; ne+ro,e t5b5l/r; +/rdite e -eri+/rdite; /-l/,i/
.ed5l/r; di,trbio, de +o/g5l/0o; He-/tite; -/n+re/tite; en+ef/lite; 52e8te; dentre
o5tro,!
"! S5,-en,o d/ drog/ ,5,-eit/!
! ReeB-o,i0o @ drog/ ,3 de2e ,er re/li/d/ e. +/,o, e,-e+i/i, e e. /.biente
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Te,te de -ro2o+/0o!
Te,te de +ont/to de let5r/ t/rdi/!
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7/24/2019 Resumo sobre Farmacodermias
http://slidepdf.com/reader/full/resumo-sobre-farmacodermias 9/9
R/dio/llergo,obent 9RAST:!
Te,te de tr/n,for./0o bl?,ti+/ de linf3+ito,!
Liber/0o de Hi,t/.in/ -elo, b/,3filo,!
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Do,/ge. ,4ri/ d/ tri-t/,e!
e.ogr/./; EAS; do,/ge. ,4ri+/ de IGE!!!
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Di/gn3,ti+o -re+o+e
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Ho,-it/l/r!
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