Psikotrop ilaçların dermatolojik yan etkileri ve tedavi yaklaşımları

Karakuş, Gonca; yücel, aydın; GÜNAŞTI, Suhan

Psikotrop ilaçların dermatolojik yan etkileri ve tedavi yaklaşımları

Aydın YÜCEL, (Çukurova Üniversitesi, Tıp Fakültesi, Dermatoloji Anabilim Dalı, Adana, Türkiye)

Gonca KARAKUŞ, (Çukurova Üniversitesi, Tıp Fakültesi, Psikiyatri Anabilim Dalı, Adana, Türkiye)

Suhan GÜNAŞTI (Çukurova Üniversitesi, Tıp Fakültesi, Dermatoloji Anabilim Dalı, Adana, Türkiye)

Klinik Psikofarmakoloji Bülteni

377 12

Yıl: 2008 Cilt: 18 Sayı: 3 Sayfa Aralığı: 235 - 244 Metin Dili: Türkçe İndeks Tarihi: 29-07-2022

Psikotrop ilaçların dermatolojik yan etkileri ve tedavi yaklaşımları

Öz:

Psikiyatrik hastalıkların tedavisinde kullanılan psikotrop ilaçlara bağlı olarak çok farklı yan etkilerin yanı sıra dermatolojik yan etkiler de gözlenebilir. Bu yan etkiler sık görülmesine karşın, çoğu zaman kolay tedavi edilebilir özelliktedir. Bununla birlikte, Stevens-Johnson sendromu, toksik epidermal nekroliz, anjiyoödem, eritrodermi, vaskülit ve ilaca bağlı döküntü-eozinofili ve sistemik bulgular gibi ölümle sonuçlanabilecek ciddi yan etkiler de görülebilir. Psikotrop ilaçlarla ortaya çıkan başlıca dermatolojik yan etkiler ürtiker, ekzantematöz döküntü, pruritus, fotosensitivite, pigmenter değişiklikler, fiks ilaç erüpsiyonu, alopesi, eritema multiforme, Stevens-Johnson sendromu, toksik epidermal nekroliz, ilaca bağı döküntü-eozinofili ve sistemik bulgular, vaskülit, eritrodermi, akneiform döküntü, psoriasiform döküntü, likenoid döküntü, lupus eritematozus, akut jeneralize ekzantematöz püstülozis, psödolenfoma ve hiperhidrozistir. Bu yan etkilerden bazılarında ateş, lenfadenopati, kan tablosunda değişiklikler gibi sistemik belirtilerin de tabloya eklenebileceği unutulmamalıdır. Sistemik bulguları olan hastalar hastaneye yatırılarak izlenmelidir. Çoklu ilaç kullanımlarında ve herhangi bir ilaca karşı allerji öyküsü veren hastalarda psikotrop ilaca bağlı dermatolojik yan etki riski daha fazla olabilmektedir. Böyle durumlarla karşılaşıldığında ilaca karşı gelişen dermatolojik yan etkilerin derlendiği kaynaklar taranarak hasta için en uygun olan ilaç seçilmeye çalışılmalıdır. Antidepresan ilaçların dermatolojik yan etkileri kadınlarda erkeklere göre daha fazla bildirilirken; lityum kullanan erkek hastalarda daha fazla yan etki ortaya çıkmaktadır. Steven-Johnson Sendromu lamotrijin kullanan çocuklarda erişkinlere göre daha sıktır. Antidepresan ve antipsikotik ilaçların hemen hepsinde ürtiker, ekzantematöz döküntü, pruritus, fotosensitivite görülebilmektedir. Antidepresan ilaçlardan şuoksetin, sertralin, amitriptilin ve imipramin; antipsikotik ilaçlardan klorpromazin, klozapin ve risperidon ile ilgili bildirilen dermatolojik yan etki çeşitleri daha fazladır. Bu durum ilaçların kulanım sıklıkları ile ilişkili olabilir. Duygudurum düzenleyici ilaçların hemen hepsinde de ürtiker, ekzantematöz döküntü ve pruritus görülebilmektedir. Tüm psikotrop ilaçları değerlendirdiğimizde ise duygudurum düzenleyici ilaçlarla ciddi dermatolojik yan etkilerin daha sık olduğu gözlenmektedir. Psikotrop ilaç tedavisine başlamadan önce hastanın geçmişte kullandığı ilaçlar ve bunlara ilişkin deri döküntüsü varlığı dikkatlice araştırılmalı; hasta gelişebilecek dermatolojik yan etkiler konusunda bilgilendirilmelidir. Tedavi başlatıldıktan sonra hasta olası dermatolojik reaksiyonlar açısından izlenmelidir. İlaca karşı reaksiyon gelişirse dermatologla işbirliği içinde durum değerlendirilmeli; gerekirse ilaç kesilerek farklı gruptan bir ilaca geçilmelidir.

Anahtar Kelime: Psikotropik ilaçlar Terapötik kullanım Yan etkiler İlaç döküntüleri İlaç toksisitesi Farmakolojik etkiler

Konular: Dermatoloji Alerji Farmakoloji ve Eczacılık

Dermatological side effects of psychotropic drugs and treatment approaches

Öz:

There are several different side effects of psychotropic drugs used in psychiatric disorders. One of these is dermatologic side effects. The majority of adverse cutaneous effects are benign and easily treated. However serious adverse effect can be seen such as Stevens Johnson Syndrome, toxic epidermal necrolysis, exfoliative dermatitis, vasculitis and drug hypersensitivity syndrome with eosinophilia. The most frequently reported cutaneous adverse effects of psychotropic medications include: urticaria, exanthematous reactions, pruritus, photosensitivity, pigmentation, fix drug eruptions, alopecia, erythema multiforme, Stevens Johnson syndrome, toxic epidermal necrolysis, drug hypersensitivity syndrome with eosinofilia and systemic symptoms, exfoliative dermatitis, acneiform eruption, psoriasiform reactions, lichenoid eruption, lupus erythematosus, acute generalized exanthematous pustulosis, pseudolymphoma and hyperhidrosis. Some systemic symptoms such as fever, lymphadenopathy and abnormal hematological examination may contribute to these side effects. In this case, patient should be hospitalized and monitored carefully. Dermatological adverse effects of psychotropic medications might increase due to a history of former drug eruptions and multiple drug usage. In this case it is recommended to search dermatological sources which include compilation of dermatological side effects due to medication and to select the most appropriate drug for the patient. Dermatological side effects of antidepressants were reported more frequently in women than men whereas male patient treated with lithium had more side effects. Children treated with lamotrigine had Stevens Johnson syndrome more frequently than adults. Almost all of the antidepressant and antipsychotic drugs cause urticaria, exanthematous reactions, pruritus and photosensitivity. In antidepressant group şuoxetine, sertraline, amitriptiline and imipramine; in antipsychotic group chlorpromazine, clozapine and risperidone seems to cause more adverse dermatological effects than others. This might be due to frequency of drug use. Almost all of the mood stabilizers cause urticaria, exanthematous reactions and pruritus. When we consider all the psychotropic drugs mood stabilizers seem to cause more serious side effects than others. Former drug history and related cutaneous side effects should be carefully investigated before starting the psychotropic medication. Besides the patients should be informed about the possible dermatological side effects. Patients should be followed for possible dermatological reactions after starting the therapy. If a skin eruption occurs, it is generally advisable to refer the patient to a dermatologist and discontinue the drug and to consider switching to another class of agent. In this manuscript we reviewed the most frequently observed dermatological adverse effects due to commonly used psychotropic drugs.

Anahtar Kelime: Therapeutic Uses Adverse effects Drug Eruptions Drug Toxicity Pharmacologic Actions Psychotropic Drugs

Konular: Dermatoloji Alerji Farmakoloji ve Eczacılık

Belge Türü: Makale Makale Türü: Derleme Erişim Türü: Erişime Açık

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APA	yücel a, Karakuş G, GÜNAŞTI S (2008). Psikotrop ilaçların dermatolojik yan etkileri ve tedavi yaklaşımları. , 235 - 244.
Chicago	yücel aydın,Karakuş Gonca,GÜNAŞTI Suhan Psikotrop ilaçların dermatolojik yan etkileri ve tedavi yaklaşımları. (2008): 235 - 244.
MLA	yücel aydın,Karakuş Gonca,GÜNAŞTI Suhan Psikotrop ilaçların dermatolojik yan etkileri ve tedavi yaklaşımları. , 2008, ss.235 - 244.
AMA	yücel a,Karakuş G,GÜNAŞTI S Psikotrop ilaçların dermatolojik yan etkileri ve tedavi yaklaşımları. . 2008; 235 - 244.
Vancouver	yücel a,Karakuş G,GÜNAŞTI S Psikotrop ilaçların dermatolojik yan etkileri ve tedavi yaklaşımları. . 2008; 235 - 244.
IEEE	yücel a,Karakuş G,GÜNAŞTI S "Psikotrop ilaçların dermatolojik yan etkileri ve tedavi yaklaşımları." , ss.235 - 244, 2008.
ISNAD	yücel, aydın vd. "Psikotrop ilaçların dermatolojik yan etkileri ve tedavi yaklaşımları". (2008), 235-244.

APA	yücel a, Karakuş G, GÜNAŞTI S (2008). Psikotrop ilaçların dermatolojik yan etkileri ve tedavi yaklaşımları. Klinik Psikofarmakoloji Bülteni, 18(3), 235 - 244.
Chicago	yücel aydın,Karakuş Gonca,GÜNAŞTI Suhan Psikotrop ilaçların dermatolojik yan etkileri ve tedavi yaklaşımları. Klinik Psikofarmakoloji Bülteni 18, no.3 (2008): 235 - 244.
MLA	yücel aydın,Karakuş Gonca,GÜNAŞTI Suhan Psikotrop ilaçların dermatolojik yan etkileri ve tedavi yaklaşımları. Klinik Psikofarmakoloji Bülteni, vol.18, no.3, 2008, ss.235 - 244.
AMA	yücel a,Karakuş G,GÜNAŞTI S Psikotrop ilaçların dermatolojik yan etkileri ve tedavi yaklaşımları. Klinik Psikofarmakoloji Bülteni. 2008; 18(3): 235 - 244.
Vancouver	yücel a,Karakuş G,GÜNAŞTI S Psikotrop ilaçların dermatolojik yan etkileri ve tedavi yaklaşımları. Klinik Psikofarmakoloji Bülteni. 2008; 18(3): 235 - 244.
IEEE	yücel a,Karakuş G,GÜNAŞTI S "Psikotrop ilaçların dermatolojik yan etkileri ve tedavi yaklaşımları." Klinik Psikofarmakoloji Bülteni, 18, ss.235 - 244, 2008.
ISNAD	yücel, aydın vd. "Psikotrop ilaçların dermatolojik yan etkileri ve tedavi yaklaşımları". Klinik Psikofarmakoloji Bülteni 18/3 (2008), 235-244.