Severe Generalized Pustular Psoriasis Provoked by Oral Terbinafine

口服terbinafine誘發全身性膿疱型乾癬

邱政偉(Jeng-Wei Tjiu) ； 蔡呈芳(Tsen-Fang Tsai) ； 朱家瑜(Chia-Yu Chu)

《中華皮膚科醫學雜誌》 22卷2期 (2004/06) Pp. 187-192

https://doi.org/10.29784/DS.200406.0010

摘要

Terbinafine是一種丙烯肢抗黴菌藥。嚴重的皮膚不良反應很少見，但是中毒性表皮壞死鬆解症、膿皰型藥疹、急性全身膿皰疹、Stevens-Johnson 徵候群與多形性紅斑皆曾經被報告過。Terbinafine也曾經被報告過引發慢性乾癬的急性惡化，或是產生膿疱型乾癬。我們報告一例乾癬病人未經黴菌學確認，即使用terbinafin。四週後出現膿疱型皮疹，雖然他立即停止使用terbinafine，但此皮疹仍在隨後的二週內逐漸惡化為全身嚴重膿疱型乾癬。Terbinafine已經被認為可能惡化或是誘發乾癬。Terbinafine是相當有效的抗黴菌藥物，但是不加選擇的使用terbinafine會造成類似我們病人這樣的不必要風險。隨著terbinafine用量的增加，嚴重的不良反應可能更為常見。因此在給予疑似甲癬病人terbinafine之前應該先做黴菌學的檢查。(中華皮誌22 : 187－192 , 2004 )

並列摘要

Terbinafine is an allylamine antifungal agent. Its severe cutaneous adverse effects are rare, but toxic epidermal necrolysis, pustular drug eruption, acute generalized exanthematous pustulosis, Stevens-Johnson syndrome, and erythema multiforme had been reported. Terbinafine was also reported to induce flare-up of chronic psoriasis or development of pustular psoriasis. Here we report a psoriatic patient who developed pustular eruptions in four weeks after treatment with terbinafine for his presumptive tinia unguium without a definitive mycological evidence, The skin eruptions progressed to severe, generalized pustular psoriasis in the following two weeks even though he discontinued terbinafine treatment. It is well recognized that terbinafine may aggravate and induce psoriasis. Terbinafine is a highly effective antifungal agent. However, with the indiscriminate use, terbinafine may cause unnecessary risk, as in our patient. With the increased systemic administration of terbinafine, severe adverse effects might become more common. Therefore, we suggest mycological examinations are essential prior to commencing terbiuafine therapy for suspected onychomycosis. (Dermatol Sinica 22: 187-192,2004)

並列關鍵字

Terbinafine ； Pustular psoriasis