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>> ¼×è¹á¾ŒÂÒª¹Ô´µ‹Ò§æ
1.urticaria áÅÐ angioedema
2. fixed drug eruption
3. erythema multiforme
4. Steven Johnson Syndrome (SJS)
5.toxic epidermal necrolysis (TEN)
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Urticaria(ÅÁ¾ÔÉ) Angioedema
ÍÒ¡ÒúÇÁºÃÔàdzÃÔÁ½‚»Ò¡áÅеÒ
ÁÑ¡à¡Ô´ÀÒÂã¹ 1-2 ªÁ. ËÃ×͹ҹ໚¹ÊÑ»´ÒˏËÅѧ䴌ÃѺÂÒ¤ÃÑé§áá
¼×è¹ÁÑ¡ÂغÀÒÂã¹ 24 ªÁ. àÁ×èÍËÂØ´ÂÒ áÅÐËÅѧ¼×è¹Âغ¨ÐäÁ‹àËÅ×ÍÃÍ·Ôé§äÇŒ
ã¹ÃÒ·ÕèÁÕÍÒ¡ÒÃᾌÃعáç ÍÒ¨¾º ËÒÂã¨Ëͺà˹×èÍ ¤ÇÒÁ´Ñ¹âÅËÔµµèÓ
áÅÐËÁ´ÊµÔ(anaphylactic shock)
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ÂÒ·Õ辺NjÒ໚¹ÊÒà˵غ‹Í : ÂÒ¡ÅØ‹Á penicillin, sulfonamide,

ÂҡѹªÑ¡, aspirin, NSAIDs, morphine, codeine, radiocontrast media
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¼×è¹á¾ŒÂÒª¹Ô´ urticaria áÅÐ angioedema

ÊÓËÃѺ¼ÙŒ»†ÇÂà´ç¡ ¼×è¹ÅÁ¾ÔɵŒÍ§á¡¨Ò¡ÊÒà˵ØÍ×è¹
ઋ¹ ¡ÒÃᾌÍÒËÒ÷ÐàŠᾌ¹ÁÇÑÇ ¡ÒõԴàª×éÍäÇÃÑÊ áÅСÒõԴàª×éÍẤ·ÕàÃÕÂ

¡ÒÃÃÑ¡ÉÒ: ·Óâ´ÂËÂØ´ÂÒ·ÕèʧÊÑ ËÇÁ¡Ñº¡ÒÃãËŒÂÒᡌᾌ㹡ÅØ‹Á antihistamine

ઋ¹ ¢¹Ò´ÂÒã¹à´ç¡ hydroxyzine 1-2 ÁÔÅÅÔ¡ÃÑÁ/¡¡./Çѹ ¹Ò¹ 3-5 Çѹ
ã¹ÃÒ·ÕèÁÕÍÒ¡ÒÃÃعáç ËÃ×ÍÁÕÍÒ¡Òà angioedema ËÇÁ´ŒÇÂ
ÍÒ¨¾Ô¨ÒóÒãËŒÂÒÊàµÕÂÃÍ´ÃѺ»ÃзҹËÃ×Í©Õ´ã¹ÃÐÂÐàÇÅÒÊÑé¹æ
- ÁÑ¡à¡Ô´ÀÒÂã¹ 1-2 ªÁ. ËÃ×͹ҹ໚¹ÊÑ»´ÒˏËÅѧ䴌ÃѺÂÒ¤ÃÑé§áá
- ¼×è¹ÁÑ¡ÂغÀÒÂã¹ 24 ªÁ. àÁ×èÍËÂØ´ÂÒ áÅÐËÅѧ¼×è¹Âغ¨ÐäÁ‹àËÅ×ÍÃÍ·Ôé§äÇŒ
- ã¹ÃÒ·ÕèÁÕÍÒ¡ÒÃᾌÃعáç ÍÒ¨¾º ËÒÂã¨Ëͺà˹×ËÅÒ¹àÁç
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áÅÐËÁ´ÊµÔ(anaphylactic shock)
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- ã¹ÃÒ·ÕèÁÕÍÒ¡ÒÃᾌÃعáç ÍÒ¨¾º ËÒÂã¨Ëͺà˹×èÍ ¤ÇÒÁ´Ñ¹âÅËÔµµèÓ
áÅÐËÁ´ÊµÔ(anaphylactic shock)
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Áѹ໚¹áººä˹ÍФÃѺÍÒËÁÍ

¼×è¹á¾ŒÂÒª¹Ô´ fixed drug eruption

Åѡɳм×è¹ : ÃٻËҧ¡ÅÁ ¢ÍºªÑ´ ÊÕá´§¨Ñ´ µÃ§¡ÅÒ§¼×è¹ÍÒ¨à»ÅÕè¹໚¹ÊÕá´§¤ÅéÓËÃ×ÍÊÕÁ‹Ç§

ËÃ×;ͧ໚¹µØ‹Á¹éÓ ¼×è¹ÍÒ¨ÁÕÍÒ¡ÒÃáʺËÃ×ͤѹ
ÃÐÂÐàÇÅÒ㹡ÒÃà¡Ô´ : ¶ŒÒä´ŒÃѺÂÒ¤ÃÑé§ááÁÑ¡à¡Ô´ËÅѧ㪌ÂÒ»ÃÐÁÒ³ 7 Çѹ
ᵋàÁ×èÍä´ŒÃѺÂÒ«éÓ¨Ðà¡Ô´¼×è¹¢Öé¹µÑé§áµ‹ã¹Á×éÍáá áÅÐà¡Ô´ã¹ºÃÔàdzà´ÔÁ ÃÍ´ÓÁÑ¡ÍÂÙ‹¹Ò¹
µÓá˹‹§·Õ辺º‹Í : ÃÔÁ½‚»Ò¡ ᢹ¢Ò ÍÇÑÂÇÐà¾È
ÂÒ·Õ辺NjÒ໚¹ÊÒà˵غ‹Í : co-trimoxazole, barbiturate, penicillin, tetracycline
¡ÒÃÃÑ¡ÉÒ : ËÂØ´ÂÒ·Õè໚¹ÊÒà˵ØËÇÁ¡Ñº¡ÒÃãËŒÂÒÊàµÕÂÃÍ´·Ò

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fixed drug eruption ¨Ð
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Åѡɳм×è¹ : ¤ÅŒÒ maculopapular rash ᵋµÃ§¡ÅÒ§¼×蹨ÐÁÕÊÕࢌÁ

ËÃ×ÍÍÒ¨¾Í§¡ÅÒÂ໚¹µØ‹Á¹éÓ àÃÕÂ¡Ç‹Ò target lesion
«Öè§à»š¹ÅѡɳÐ੾ÒТͧ¡ÒÃᾌÂÒª¹Ô´¹Õé
ÃÐÂÐàÇÅÒ㹡ÒÃà¡Ô´¼×è¹ : ÀÒÂËÅѧ䴌ÃѺÂÒ 1-2 ÊÑ»´Òˏ
µÓá˹‹§·Õ辺º‹Í : ½†ÒÁ×Í ½†Òà·ŒÒ á¢¹¢Ò ÁÑ¡¨Ð໚¹·Ñé§ 2 ¢ŒÒ§
àÂ×èͺØÀÒÂã¹Ã‹Ò§¡Ò ÍÒ¨¨Ð¤Ñ¹ËÃ×ÍäÁ‹¡çä´Œ
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¼×è¹á¾ŒÂÒª¹Ô´ erythema multiforme

ÊÒà˵Ø: 50%à¡Ô´¨Ò¡ÂÒ àª‹¹ sulfonamides, barbiturates, NSAIDS, phenyltoin,
allopurinol, penicillin ʋǹ·ÕèàËÅ×Íà¡Ô´¨Ò¡µÔ´àª×éÍઋ¹ àÃÔÁ ¡ÒõԴàª×éÍ mycoplasma
ÇѤ«Õ¹ (BCG â»ÅÔ âÍ) ËÃ×Í àª×éÍÃÒºÒ§ª¹Ô´

¶ŒÒ¾º¼×è¹Ã‹ÇÁ¡ÑºÁÕ䢌ÊÙ§áÅоº¼×è¹·Õè mucous membrane ÁÒ¡¡Ç‹Ò 1 áË‹§ ઋ¹

àÂ×èͺعѹµÒ ÀÒÂã¹»Ò¡ ÍÇÑÂÇÐà¾È àÃÕ¡ Stevens-Johnson Syndrome (SJS)

¡ÒÃÃÑ¡ÉÒ ¤×Í ¾ÂÒÂÒÁËÒÊÒà˵آͧâä áÅÐÃÑ¡ÉÒµÒÁÍÒ¡ÒÃ

¶ŒÒ໚¹ erythema multiforme ¼×蹨ÐËÒÂÀÒÂã¹ 1-2 ÊÑ»´Òˏ ¡çàÁç´ÂÒ¨Ðä´ŒÃٌNjÒ
ᵋ¶ŒÒ SJS µŒÍ§ÃѺ¼ÙŒ»†ÇÂäÇŒã¹Ã¾.à¾×èÍ´ÙáÅÍ‹ҧã¡ÅŒªÔ´ àÁç´ÂÒÁÕâÍ¡ÒÊàÊÕè§
·Õè¨ÐᾌÂÒËÃ×Íà»Å‹Ò䧤ÃѺ

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Stevens-Johnson¨ÐÁÕ¼×è¹á´§áÅÐÅÍ¡
(ÅÍ¡ <10%) ·ÕèÊÓ¤ÑިеŒÍ§ÁÕ¼×è¹·ÕèàÂ×èÍ͋͹
ઋ¹ àÂ×èͺØã¹»Ò¡ µÒ ÍÇÑÂÇÐà¾È ·ÇÒÃ˹ѡ
·‹Í»˜ÊÊÒÇÐ ËÃ×ÍÁÕÍÒ¡ÒáÅ×¹ÍÒËÒÃÅÓºÒ¡
ËÃ×Ͷ‹ÒÂàËÅÇ

ÍÒ¡Òú‹§ªÕéÇ‹ÒÍҨᾌÂÒẺ SJS 䴌ᡋ:

ÁÕ䢌ÊÙ§ »Ç´àÁ×èÍ à¨çº¤Í ¤ÅŒÒÂÍÒ¡ÒÃ䢌ËÇÑ´
(·ÕèäÁ‹ãª‹ÍÒ¡Ò÷ÕèÁÕÍÂÙ‹à´ÔÁ) ËÇÁ¡Ñº
ÁÕ¼×è¹ µØ‹Á¾Í§ ËÃ×ͨشᴧºÃÔàdz¼ÔÇ˹ѧ
à¨çºµÒ ˹ѧµÒºÇÁá´§ àÂ×èͺصÒÍÑ¡àʺ

¹‹Ò¡ÅÑǨѧàŤÃѺ
¾Õèà¢ÒᾌÂÒẺ SJS ¨Ð ÍÒËÁÍ
ËÅÒ¹àÁç´ÂÒ
«Öè§à»š¹ÍÒ¡ÒÃᾌÂÒ·ÕèÃعáç
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Steven Johnson Syndrome (SJS)

ÊÒà˵Ø: ÂÒ·Õ辺䴌º‹ÍÂ䴌ᡋ ÂÒ»¯ÔªÕǹР(sulfa, penicillin), NSAIDs, allopurinol,

phenytoin, carbamazepine, barbiturates, ÂÒµŒÒ¹äÇÃÑÊ HIV
ÊÒà˵ØÍ×è¹æ: ¡ÒõԴàª×éÍઋ¹ Mycoplasma, herpes simplex virus 1 ËÃ×Í
2 Streptococcus species, Histoplasma capsulatum, influenza virus,
áÅÐ adenovirus ¡ÒéմÇѤ«Õ¹âäºÒ§ª¹Ô´àª‹¹ systemic lupu

¡ÒÃÃÑ¡ÉÒ:
 ËÒ¡¤Ô´¶Ö§ÂÒãËŒËÂØ´ÂÒ·Õè໚¹ÊÒà˵طѹ·Õ ¼ÙŒ»†ÇÂÁÑ¡ä´ŒÃѺÂÒ¡‹Í¹à¡Ô´ÍÒ¡ÒÃ
 1 – 3 ÍҷԵ ËÒ¡¼ÙŒ»†ÇÂà¤Âä´ŒÃѺÂÒËÃ×Íà¤ÂᾌÁÒ¡‹Í¹¨Ðà¡Ô´àÃçÇ

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¤×Í TEN ¨Ð TEN ·Õèá»ÅÇ‹Ò 10
㪋äËÁ¤ÃѺÍÒËÁÍ

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¡‹Í¹ÁÕ¼×è¹¢Öé¹·ÑèǵÑÇ Áյ؋Á¹éӾͧ áÅÐÁÕÅѡɳÐËÔÇ˹ѧËÅØ´§‹ÒÂàÁ×èÍ㪌¹ÔéǶÙàºÒæ
(Nikolsky’s sign positive)¼ÔÇ˹ѧÅ͡໚¹á¼‹¹ãËÞ‹¤ÅŒÒ¶١¹éÓÌ͹ÅÇ¡ >30%
¢Í§¾×é¹·Õè¼ÔÇ˹ѧ·Ñé§ËÁ´ áÅÐÁÕ¤ÇÒÁ¼Ô´»¡µÔ¢Í§àÂ×èͺØÀÒÂã¹Ã‹Ò§¡ÒÂËÇÁ´ŒÇÂ
ÂÒ·Õè໚¹ÊÒà˵غ‹Í : ÂÒ»¯ÔªÕǹР(sulfa, penicillin), NSAIDs, phenobarbital, phenytoin,
carbamazepine, allopurinol, barbiturates, ÂÒµŒÒ¹äÇÃÑÊ HIV

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TEN ·Õè໚¹¼×è¹á¾ŒÂÒ
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㹡óշÕè¼×è¹á¾ŒäÁ‹Ãعáç ઋ¹ maculopapular rash, Fixed drug eruption
ËÃ×Í Eczematous reaction
-ÃѺ»ÃзҹÂÒ antihistamine
-ãËŒÂÒ·Òá¡Œ¤Ñ¹ ઋ¹ calamine
-ãËŒÂÒ·ÕèãËŒ¤ÇÒÁªØ‹Áª×鹡Ѻ¼ÔÇ˹ѧ (emollients)
-ãËŒÂÒÊàµÕÂÃÍ´·Òã¹ÃÒ·Õè໚¹ fixed drug eruption
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mononucleosis »Ç´·ŒÍ§¤‹ÍÂ໚¹¤‹ÍÂ仹ҹ 1 – 3 ÊÑ»´Òˏ

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infectiosum ÁÕÍÒ¡ÒÃÍÑ¡àʺ¢Í§¢ŒÍãËÞ‹ «Ö觵‹Ò§¨Ò¡ã¹
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Measles - Çѹ·Õè 2 – 3 ¢Í§ä¢Œ (¡‹Í¹ÍÍ¡¼×è¹ 2 – 3 Çѹ) ¨Ð¾º koplik’s spot

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Infactious ÁÕ䢌 à¨çº¤Í ·Í¹«ÔÅÍÑ¡àʺ ÍÒ¨¾º tonsillar patch,

mononucleosis lymphadenopathy µÑºâµÁŒÒÁⵠ˹ѧµÒºÇÁ ¼×è¹¾ºä´Œà¾Õ§ÌÍÂÅÐ
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infectiosum µ‹ÍÁÒ ¨Ö§àÃÔèÁÁÕ¼×¹·Õèᢹ¢Ò reticulate erythema ËÃ×Í໚¹
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