22歲女大生施打疫苗後引發嚴重藥物疹
2022-09-28 記者 蘇旋/台南報導
一位22歲的女大生寶兒(化名)，4月底打完第三劑新冠肺炎(COVID-19)疫苗的幾天後，全身皮膚開始陸續出現會癢的紅疹，就醫的診所以高劑量類固醇治療一個多月，症狀卻一直無法有效控制，而且只要類固醇減量，紅疹就變得更嚴重並遍布全身，臉上也因為長期吃高劑量類固醇而變得雍腫，還長出很多痘痘，讓她每天都癢到睡不著覺，生活完全被打亂，最後輾轉至奇美醫學中心皮膚科求治，通過使用免疫抑制劑-環孢靈合併低劑量類固醇治療，皮膚症狀終於完全復原。
奇美醫學中心皮膚科暨醫學美容中心主治醫師莊琇（圖/奇美醫學中心提供）
奇美醫學中心皮膚科暨醫學美容中心主治醫師莊琇真醫師細心診視並進行抽血檢驗與皮膚切片檢查，發現寶兒有嚴重皮疹，全身面積高達70%以上，血液報告非典型淋巴球、嗜伊紅性白血球及肝指數上升，皮膚切片顯示大量嗜伊紅性白血球浸潤，因此診斷寶兒非一般的皮膚過敏，而是施打疫苗後引發的嚴重藥物疹。
莊醫師細心診視後，因此診斷寶兒非一般的皮膚過敏，而是施打疫苗後引發的嚴重藥物疹。（圖/奇美醫學中心提供）
莊醫師評估寶兒的狀況後，先使用免疫抑制劑-環孢靈合併低劑量類固醇治療，一週後，紅疹與皮膚癢問題明顯改善且不再有新病灶產生。二週後，紅疹幾乎完全褪去，僅剩色素沉著。第三週，開始停用類固醇並減量免疫抑制劑-環孢靈治療。經過數週的逐步調降劑量治療，困擾寶兒幾個月的皮膚症狀終於完全復原，臉上的痘痘也改善了許多，而且停藥後也沒有復發。
莊琇真醫師說，自從2020年初新冠肺炎(COVID-19)肆虐全球以來，為了對抗高死亡率的病毒感染，世界各國陸續研發出各種COVID-19疫苗供人們施打。然而COVID-19疫苗施打後也出現了一些副作用，常見的如：發燒、注射處疼痛、頭痛或全身痠痛等等，也有不少民眾會產生皮膚癢或紅疹等過敏反應。
莊琇真醫師指出，施打COVID-19疫苗產生皮膚不良反應的機轉主要為第一型(急性)過敏反應或是第四型(延遲性)過敏反應，另外還包括了自體免疫反應或其他機轉。第一型過敏反應通常在數分鐘至數小時內發生，包括：蕁麻疹、血管性水腫、過敏性休克。第四型過敏反應則較晚發生，可能隔天後才陸續出現症狀，例如：新冠手臂(COVID arm)、麻疹樣皮疹、多型性紅斑或醫美填充物的發炎反應等。而自體免疫反應則可能引起免疫性血小板低下症、血管炎、皮膚紅斑狼瘡或類天疱瘡等皮膚症狀。
主講者皮膚科暨醫學美容中心主治醫師莊琇真及其講題
莊琇真醫師表示，施打COVID-19疫苗後造成的皮膚不良反應，大部分是輕微且自限性或是藥物治療能夠控制的，因此不需限制同種疫苗的再次施打，除非出現過敏性休克、注射疫苗4小時內出現蕁麻疹、血管性水腫或是嚴重皮膚不良反應等症狀才需避免。疫苗引發嚴重皮膚不良反應的狀況非常罕見，民眾不需過度恐慌，只要保持警覺，一旦出現廣泛皮下出血點或瘀青、廣泛性皮疹合併發燒、呼吸困難或是合併表皮及黏膜破損，儘速就醫即可。雖然疫苗多少有副作用，但在COVID-19疫情仍然延燒的當下，施打疫苗仍是利大於弊，也是預防重症及降低死亡率最好的方法。呼籲民眾除非特殊體質，否則還是要把疫苗打好、打滿，以守護自己和家人的健康！
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