Erythema multiforme exudative treatment with antibiotics. Symptoms at the onset of the disease

Exudative erythema multiforme is an acute disease that is prone to exacerbations. Clinically this pathology manifests itself as rashes on the skin and mucous membranes.

Erythema multiforme, photo which is posted below, can occur in people of any age, but most often occurs in children 5-6 years old and young people aged 18-21 years.

Erythema multiforme, photo which can be seen below, there are two types - idiopathic and symptomatic.

The photo shows erythema multiforme

The causes of idiopathic erythema are not clear. The symptomatic form may occur:

after taking medications (amidopyrine, tetracycline, sulfonamides and a number of others);
after preventive vaccinations;
if available malignant neoplasms in internal organs;
for some infectious and rheumatic pathologies.

Multimorphic erythema: symptoms

Exudative erythema (photo which is posted below), begins to manifest itself clinically with prodromal symptoms that develop under the influence of provoking factors.

The photo shows exudative erythema

The symptomatic form develops while taking medicines or after vaccinations. Further, both forms of the disease proceed approximately the same.

With erythema multiforme, widespread skin lesions are observed on the extremities (mainly hands and forearms), less often on the neck and face. It often occurs exudative erythema multiforme in the oral cavity.

Initially, bright red round spots appear on the skin, having clearly defined boundaries and a diameter of 2-15 millimeters.

Ridges form along the edges of the rash, and over time the center acquires a bluish tint. The spots merge, forming bizarre ring-shaped patterns on the patient’s skin.

Along with the spots, separately located blisters and blisters may appear. In this case, they talk about the bullous form of erythema.

Rashes may appear on reproductive organs and in skin folds. In this case, over time they turn into erosions covered with purulent or bloody crusts. The appearance of new rashes is accompanied by headaches, general weakness and an increase in temperature.

This whole process lasts about one and a half to two weeks and ends full recovery. Sometimes hyperpigmentation may be observed in areas where the rashes were.

Symptomatic polymorphic exudative erythema has similar clinical signs, but its occurrence is not associated with exposure to infections, and relapses are not associated with the change of season. Symptomatic erythema occurs after repeated administration of a drug that is an allergen for the patient's body.

With this form, rashes are more common; they can be observed not only on the skin, but also on the mucous membranes oral cavity. In addition to spots, painful blisters often form, which significantly worsen the patient’s quality of life.

Exudative erythema multiforme in children

Erythema multiforme exudative is a disease that affects the skin and oral mucosa of a child. It occurs quite rarely in infants, most often this form diagnosed in older children and adolescents.

The prodromal period lasts several days and is manifested by a deterioration in the general condition of the child, low-grade fever, lethargy, weakness, sore throat, crying and anxiety due to joint and muscle pain.

After this, rashes appear on the child’s skin, which are localized on the limbs, face, neck and sometimes on the body. Depending on the form of the disease, the rash may take the form of spots, blisters, papules, and blisters. Central part the spots are sunken, the edges are swollen and slightly raised.

In severe cases, hemorrhagic blisters may appear, when opened, erosions covered with a blood crust form on the surface of the child’s skin.

In addition to the skin, damage to the oral mucosa and conjunctiva may be observed. After about 5-6 weeks, the rash completely disappears, and the patient recovers (in about a fifth of patients, relapses may occur).

Exudative erythema multiforme: photos, diagnosis

Exudative erythema multiforme, photo which can be seen below, has many causes and manifests itself in different ways, so it is necessary for the diagnosis to be comprehensive.

The photo shows erythema multiforme

After interviewing and examining the patient, the doctor takes fingerprint smears from the lesions and sends the patient to donate blood. About allergic origin erythema says increased content eosinophils.

To identify an allergen (dust, food, etc.), skin tests are indicated.

If the test results reveal eosinophilia, then it is necessary to donate blood for IgE antibodies.

Erythema multiforme is a disease in which there is inadequate reaction immune system to the effects of antigens, therefore, during diagnosis it is necessary to examine immunity. An immunogram in this case will show a deficiency of interferon gamma in the patient’s blood.

It is also necessary to carry out differential diagnosis from aphthous stomatitis, Lyell's syndrome, lupus erythematosus, erythema nodosum.

Exudative erythema multiforme: treatment

With a pathology such as exudative erythema, treatment largely depends on the form of the disease.

At frequent relapses, lesions of the mucous membrane, the appearance of necrotic areas, the patient is injected with two milliliters of Diprospan once.

At allergic form the main task is to identify and remove from the patient's body the allergen that caused the development of such a pathology as For this purpose, the prescription of heavy drinking, diuretics and enterosorbents is indicated.

Multimorphic erythema (photo which can be seen below) can also be treated with desensitization therapy. For this purpose, Tavegil, Suprastin, Clarisens, and so on can be prescribed. Antibacterial drugs are prescribed only if a secondary infection is observed.

The photo shows polymorphic erythema

Besides systemic therapy diseases erythema multiforme, treatment may also be local.

It consists of lubricating the affected areas with ointments containing corticosteroids. In addition, antiseptics are used, applications with antibacterial drugs and proteolytic enzymes are applied.

If rashes appear on the oral mucosa, rinsing with antibacterial and astringents, lubrication of lesions sea buckthorn oil. During periods of exacerbation, it is recommended to include non-irritating liquid foods in the diet.

This acute illness skin and mucous membranes with polymorphic rashes and a tendency to relapse, mainly in the autumn and spring periods. Diagnosis of multiform exudative erythema carried out by excluding diseases similar in clinical picture during the study of fingerprint smears, tests for syphilis, etc. Since exudative erythema multiforme has allergic mechanism development, in its treatment important involves eliminating the etiological factor.

ICD-10

L51 Erythema multiforme

General information

Exudative erythema multiforme occurs mainly in young and middle-aged people. It may be associated with sensitization of the body to various drugs or develop against the background of certain infectious diseases. In the first case, they speak of a toxic-allergic (symptomatic) form of exudative eczema multiforme, and in the second - of an infectious-allergic (idiopathic) form. Toxic-allergic variants of exudative erythema multiforme account for only up to 20% of all cases of the disease, while the bulk of them are associated with exposure to infectious agents.

Reasons

The cause of the development of the toxic-allergic form is intolerance medicines: barbiturates, sulfonamides, tetracycline, amidopyrine, etc. It can also occur after vaccination or serum administration. Moreover, from the point of view of allergology, the disease is a hyperreaction mixed type, combining signs of delayed and immediate types.

Symptoms of erythema multiforme

Infectious-allergic erythema

The infectious-allergic variant has an acute onset in the form of general malaise, headache, fever, muscle pain, arthralgia, and sore throat. After 1-2 days in the background general changes rashes appear. In approximately 5% of cases they are localized only on the oral mucosa. In 1/3 of patients, damage to the skin and oral mucosa is noted. IN in rare cases Multiform exudative eczema affects the genital mucosa. After the rash appears, general symptoms gradually disappear, but can persist for up to 2-3 weeks.

Skin rashes with exudative erythema multiforme are located mainly on the back of the feet and hands, on the palms and soles, on the extensor surface of the elbows, forearms, knees and shins, and in the genital area. They are represented by flat, edematous papules of a red-pink color with clear boundaries. Papules quickly increase from 2-3 mm to 3 cm in diameter. Their central part sinks, its color acquires a bluish tint. Blisters with serous or bloody contents may appear on it. The same blisters also appear on apparently healthy areas of the skin. The polymorphism of rashes is associated with the simultaneous presence of pustules, spots and blisters on the skin. The rash is usually accompanied by a burning sensation, and sometimes itching is observed.

When the oral mucosa is damaged, elements of exudative erythema multiforme are located in the area of the lips, palate, and cheeks. At the beginning, they appear as areas of limited or diffuse redness of the mucous membrane. After 1-2 days, blisters appear in areas of exudative erythema multiforme, which open after 2-3 days and form erosions. Merging with each other, erosions can cover the entire oral mucosa. They are covered with a gray-yellow coating, the removal of which leads to bleeding.

In some cases of exudative erythema multiforme, mucosal damage is limited to a few elements without severe pain. In others, extensive erosion of the oral cavity prevents the patient from speaking or even eating liquid food. In such cases, bloody crusts form on the lips, which makes it difficult for the patient to open his mouth. Skin rashes resolve on average after 10-14 days, and disappear completely after a month. The process on the mucous membrane can take 1-1.5 months.

Toxic-allergic erythema

The toxic-allergic form of exudative erythema multiforme usually does not have initial common symptoms. Sometimes before the rash there is a rise in temperature. By the nature of the elements of the rash, this form is practically no different from infectious-allergic erythema. It can be fixed and widespread. In both cases, the rash usually affects the oral mucosa. In the fixed version, during relapses of exudative erythema multiforme, rashes appear in the same places as before, as well as on new areas of the skin.

Characteristic is the recurrent course of exudative erythema multiforme with exacerbations in the spring and autumn seasons. In the toxic-allergic form of the disease, the seasonality of relapses is not as pronounced. In some cases, exudative erythema multiforme has a continuous course due to repeated relapses one after another.

Diagnostics

To diagnose the disease, a thorough examination of the rash and dermatoscopy is performed at a consultation with a dermatologist. When collecting anamnesis, attention is paid to the connection with infectious process or administration of drugs. To confirm the diagnosis of exudative eczema multiforme and exclude other diseases, fingerprint smears are taken from the surface of the affected areas of the skin and mucous membranes.

Exudative erythema multiforme is differentiated from pemphigus, disseminated form of SLE, and erythema nodosum. The rapid dynamics of the rash, negative Nikolsky's sign and the absence of acantholysis in impression smears make it possible to differentiate exudative erythema multiforme from pemphigus.

With fixed forms of exudative erythema multiforme, it is necessary to carry out differential diagnosis with syphilitic papules. Absence of pale treponema when examined in a dark field, negative PCR reactions, RIF and RPR can exclude syphilis.

Treatment of exudative erythema multiforme

Treatment in the acute period depends on clinical manifestations. In case of frequent recurrence, damage to the mucous membranes, disseminated skin rashes, and the appearance of necrotic areas in the center of the rash elements, the patient is advised to administer a single dose of betamethasone. For toxic-allergic form priority treatment is to identify and remove from the body the substance that provoked the occurrence of erythema multiforme. For this, the patient is prescribed drinking plenty of fluids, enterosorbents, diuretics. When a case of the disease occurs for the first time or if there is a history of evidence of independent rapid resolution of its relapses, the administration of betamethasone, as a rule, is not required.

For any form of exudative erythema multiforme, desensitizing therapy is indicated: chloropyramine, clemastine, sodium thiosulfate, etc. Antibiotics are used only in case of secondary infection of the rash. Local treatment exudative erythema multiforme involves the use of antibiotic applications with proteolytic enzymes, lubricating the affected skin with antiseptics ( chlorhexidine solution or furatsilin) and corticosteroid ointments, which include antibacterial drugs. If the oral mucosa is affected, rinsing with chamomile decoction, rotokan, and lubrication with sea buckthorn oil is prescribed.

Prevention

Prevention of relapses of exudative erythema multiforme in the infectious-allergic form is closely related to the identification and elimination of chronic infectious foci and herpetic infection. For this, the patient may need to consult an otolaryngologist, dentist, urologist and other specialists. With the toxic-allergic variant of exudative erythema multiforme, it is important to avoid taking the medication that provokes the disease.

Erythema multiforme exudative is an acute, often recurrent disease of the skin and mucous membranes of infectious-allergic origin, a polyetiological disease, predominantly of toxic-allergic origin, most often developing under the influence of infections, especially viral ones, and exposure to medications. This disease was first described by Hebra in 1880.

The causes and pathogenesis of erythema multiforme exudative remain unclear. But many scientists believe that the disease is of toxic-allergic origin. The disease is considered to be a hypereric reaction directed at keratinocytes. In the blood serum of patients, circulating immune complexes and deposition of the IgM and C3 components of complement is noted in the blood vessels of the dermis. Trigger factors can be viral and bacterial infections, medicines. A connection with rickettsiosis has been noted. There are two forms of the disease: idiopathic with an unknown etiology and secondary with an identified etiological factor.

Symptoms of erythema multiforme exudative. Clinically manifested by small erythematous edematous spots, maculopapular rashes with eccentric growth with the formation of double-circuit elements due to a brighter peripheral and bluish central part. Ring-shaped, cockade-shaped figures, vesicles, and in some cases blisters with transparent or hemorrhagic contents, and vegetation may appear. Preferred localization is the extensor surfaces, especially upper limbs. Rashes often occur on the mucous membranes, which is more typical for the bullous form of exudative erythema multiforme. The most severe clinical variety The bullous form of the disease is Stevens-Johnson syndrome, which occurs with high temperature, joint pain. There may be signs of myocardial dystrophy and damage to other internal organs(hepatitis, bronchitis, etc.). There is a tendency of exudative erythema multiforme to relapse, especially in the spring and autumn.

IN clinical practice There are two forms of exudative erythema multiforme - idiopathic (classical) and symptomatic. In the idiopathic form, it is usually not possible to determine the etiological factor. In the symptomatic form, a specific factor causing the rash is known.

The idiopathic (classical) form usually begins with prodromal symptoms (malaise, headaches, fever). After 2-3 days, symmetrically located limited spots or flattened edematous papules of round or oval shape, 3-15 mm in size, pink-red or bright red in color, increasing along the periphery. The peripheral ridge becomes cyanotic, and the central part sinks. In the center of individual rashes, new papular elements are formed with exactly the same development cycle. On the surface of the elements or on unchanged skin, vesicles of different sizes appear, blisters with serous or hemorrhagic contents, surrounded by a narrow inflammatory rim (“bird’s eye symptom”). After some time, the bubbles subside and their rim becomes cyanotic. In such areas, concentric figures are formed - herpes iris. Their dense cover breaks open and erosions form, which quickly become covered with dirty, bloody crusts.

The preferred localization of the elements is the extensor surfaces of the upper extremities, mainly the forearms and hands, but they can also be located on other areas - the face, neck, legs, and bottom of the feet.

Damage to the mucous membrane and lips occurs in approximately 30% of patients. At the beginning, swelling and hyperemia occur, and after 1-2 days, vesicles or blisters appear. They quickly open up, revealing bleeding, bright red colored erosion, along the edges of which the remains of tires droop. The lips swell, their red border becomes covered with bloody and dirty crusts and more or less deep cracks. Due to severe pain, eating can be very difficult. The outcome in most cases is favorable, the disease usually lasts 15-20 days and disappears without a trace, rarely a slight pigmentation remains in the areas of the rash for some time. Sometimes the process can transform into Stevens-Johnson syndrome. The idiopathic form is characterized by seasonality of the disease (in the spring and autumn months) and relapses.

In the symptomatic form, rashes similar to classic exudative erythema appear. Unlike classic type the occurrence of the disease is associated with the use of a specific agent, no seasonality is noted, the process is more widespread. In addition, the skin of the face and torso is no less affected; the cyanotic hue of the rash is not so pronounced; ring-shaped and “iris” shaped rashes, etc., may be absent.

Drug-induced exudative erythema multiforme is mostly of a fixed nature. From morphological elements blisters predominate, especially when the process is localized in the oral cavity and genitals.

Depending on the clinical picture of the rash, macular, papular, maculopapular, vesicular, bullous or vesiculobullous forms of exudative erythema are distinguished.

Histopathology of erythema multiforme exudative. The histopathological picture depends on the clinical nature of the rash. In the maculopapular form, spongiosis and intracellular edema are observed in the epidermis. In the dermis, swelling of the papillary layer and perivascular infiltration are observed. The infiltrate consists of lymphocytes and a certain amount of polymorphonuclear leukocytes, sometimes eosinophils. In bullous rashes, blisters are localized under the epidermis and only in old rashes can they sometimes be found intraepidermally. The phenomena of acantholysis are always absent. Sometimes extravasates of red blood cells are visible without signs of vasculitis.

Pathomorphology of erythema multiforme exudative. Changes in the epidermis and dermis are characteristic, but in some cases the epidermis changes predominantly, in others - the dermis. In this regard, three types of lesions are distinguished: dermal, mixed dermo-epidermal and epidermal.

With the dermal type, infiltration of the dermis is observed varying intensity, sometimes occupying almost its entire thickness. Infiltrates consist of lymphocytes, neutrophils and eosinophils, granulocytes. With severe swelling of the papillary dermis, blisters can form, the covering of which is the epidermis together with the basement membrane.

The dermal-epidermal type is characterized by the presence of a mononuclear infiltrate, located not only perivascularly, but also near the dermal-epidermal junction. Hydropic degeneration is noted in the basal cells, and necrobiotic changes are observed in the spinous cells. In some areas, infiltrate cells penetrate the epidermis and, as a result of spongiosis, can form intraepidermal vesicles. Hydropic degeneration of basal cells in combination with severe swelling of the papillary dermis can lead to the formation of subepidermal blisters. Quite often, with this type, extravasates from red blood cells are formed.

With the epilermadic type, only weak infiltration is observed in the dermis, mainly around the superficial vessels. As part of the epidermis, even in early stages There are groups of epithelial cells with necrosis, which then undergo lysis and merge into a continuous homogeneous mass, which separates to form a subepidermal bubble. This picture is similar to that of toxic epidermal necrolysis (Lyell's syndrome). Sometimes necrobiotic changes are noted in superficial sections epidermis and, together with edema, lead to the formation of subthreshold blisters with further rejection upper sections. In these cases, it is difficult to differentiate exudative erythema multiforme from dermatitis herpetiformis and bullous pemphigoid.

Histogenesis of erythema multiforme exudative. The main mechanism of development of the disease is most likely immune. In patients, direct immunofluorescence microscopy reveals a high titer of intercellular circulating antibodies, but the results of direct immunofluorescence microscopy of the affected tissue are negative. These antibodies are capable of fixing complement, unlike antibodies in pemphigus. Scientists found an increase in lymphokines and macrophage factor, indicating a cellular immune response. In the cellular infiltrate in the dermis, predominantly T-lymphocytes-helpers (CD4+) are detected, and in the epidermis - predominantly cytotoxic T lymphocytes(CD8+). Immune complexes are also involved in pathogenesis, which is primarily manifested by damage to the walls blood vessels skin. Thus, it is assumed that a combined immune reaction, including delayed type hypersensitivity reaction (type IV) and immunocomplex allergic reaction (III type). An association of the disease with the HLA-DQB1 antigen was revealed.

Differential diagnosis is carried out with fixed sulfanilamide erythema, disseminated lupus erythematosus, erythema nodosum, bullous pemphigoid, pemphigus, urticaria, allergic vasculitis.

Treatment of erythema multiforme exudative. For macular, papular and mild bullous forms, symptomatic treatment- hyposensitizing agents (calcium preparations, sodium thiosulfate), antihistamines and externally - aniline dyes, corticosteroid drugs. In severe cases, corticosteroids are prescribed orally (50-60 mg/day) or by injection; in the presence of a secondary infection - antibiotics, herpes infection - antiviral drugs(acyclovir).

The term "erythema" covers a broad group of skin diseases, accompanied by a pronounced rush of blood to the capillary vessels. Exudative multiforme is called erythema, which is characterized by an acute course and periodic relapses. The following photos will introduce you closer to this type of disease.

Exudative erythema multiforme in the photo

It is important to note that the term “exudative erythema” is also used when necessary to indicate clinically similar symptoms. The photo above shows an example of the external symptoms of this phenomenon.

Where does the disease come from?

Obtaining a photo of erythema multiforme is facilitated by the development of allergies or an underlying disease of an infectious nature.

Forms of the disease

Taking into account the above etiology, the multiform exudative erythema shown in the photo has an infectious or toxic-allergic form.

Other reasons

Along with other factors, hypersensitivity to the activity of staphylococcus, streptococcus, and E. coli can contribute to the development of erythema multiforme shown in the photo, including bullous.

Symptoms at the onset of the disease

IMPORTANT TO KNOW!

The disease begins acutely - with fever, severe migraines, joint and muscle pain. If exudative erythema multiforme, as in the photo, develops in the oral cavity, a sore throat may occur.

Further symptoms

The question is how to treat strange condition, in patients with exudative erythema multiforme, it usually occurs after two days. It is during this period that the rashes shown in all the photos form on the surface of the skin.

More about the nature of the rash

painful pinkish spots with reddish papules that quickly grow to several centimeters and merge. Serous vesicles are often observed in the center of the spots - they rupture and form erosions.

Localization of the rash

Favorite sites of erythema lesions are the feet, palms, folds of the arms and legs, forearm, intimate area. Sometimes the rash affects the mucous membranes.

Diagnostic Basics

Since erythema multiforme develops as a result of allergies, diagnosis is based on allergy tests.

Treatment Basics

First of all, they strive to eliminate the patient’s contact with allergens. Along with this, antihistamines, enterosorbents, and in severe cases, antibiotics and corticosteroids are prescribed.

Possible complications

Erythema multiforme is dangerous against the background of prolonged fever and processes of unification of erosions on the mucous membranes. In such cases, complications such as myocarditis and meningoencephalitis, which in turn can be fatal, cannot be excluded.

General forecast

In general, the treatment prognosis is favorable. The main thing is to follow the instructions of the attending physician.

Which doctors should you contact if you have Exudative erythema multiforme of the oral cavity?

What is Exudative erythema multiforme of the oral cavity?

Exudative erythema multiforme (erythema exudativum multiforme)- inflammatory disease mucous membranes and skin, characterized by polymorphism of lesion elements (bubbles, spots, blisters).

The mucous membrane of the mouth or the skin can be affected in isolation, but their combined involvement is common. Exudative erythema multiforme is characterized by an acute onset and a long, recurrent course. Exacerbations are recorded mainly in the autumn-spring period. Mostly people get sick young(20-40 years old), most often men.

What causes Exudative erythema multiforme of the oral cavity?

The etiology and pathogenesis are not fully understood. According to the etiological principle, there are 2 types of exudative erythema multiforme. The true, or idiopathic, form, which has an infectious-allergic nature, is diagnosed in the majority of patients (up to 93%). Using skin tests in this form of the disease, sensitization to bacterial allergens is detected. The source of sensitization is foci chronic infection. Decreased body reactivity due to hypovitaminosis, hypothermia, viral infections, stress provokes an exacerbation of exudative erythema multiforme.

The toxicoallergic, or symptomatic, form of exudative erythema multiforme - Stevens-Johnson syndrome, diagnosed less frequently, has a similar clinical picture with true infectious-allergic exudative erythema multiforme, but in essence it is a hyperergic reaction of the body to drugs (antibiotics, salicylates, amidopyrine, etc.).

Pathogenesis (what happens?) during Exudative erythema multiforme of the oral cavity

The disease begins suddenly with malaise, chills, weakness, and increased body temperature (in severe cases, up to 38 °C and above). Patients complain about headache, aching pains throughout the body, pain in muscles and joints, in the throat. After 1-2 days, bluish-red spots appear on the hands, forearms, legs, and sometimes the face and neck, slightly rising above the surrounding skin. Their central part sinks slightly and takes on a bluish tint, while the peripheral part retains a pinkish-red color (cockades). Subsequently, a subepidermal bubble filled with serous or hemorrhagic contents may appear in the central part. Skin rashes are sometimes accompanied by itching and burning or generally go away without pain.

The mucous membranes of the lips, cheeks, floor of the mouth, tongue, soft palate. The first manifestations of exudative erythema multiforme in the oral cavity are diffuse or limited erythema and swelling of the mucous membrane, against which subepithelial blisters appear different sizes. Damage to the oral mucosa is accompanied by sharp pain even at rest. When moving the tongue and lips, the pain increases sharply, making it difficult to eat. Patients are starving, which further worsens their condition. The blisters open quite quickly, forming painful erosions on the oral mucosa, covered with fibrinous plaque. On the red border of the lips, erosions become covered with bloody crusts, making it difficult to eat and open the mouth. In the first days after the opening of the blisters, along the edges of the erosions one can see grayish-white remnants of the covering of the blisters; when pulled, the epithelium cannot be stratified (negative Nikolsky's sign). Poor oral hygiene and the presence of carious teeth aggravate the course of exudative erythema multiforme. Infection of erosive surfaces with oral microflora occurs. Sometimes the course of exudative erythema multiforme is complicated by the addition of fusospirochetosis. Erosion on the oral mucosa becomes covered with a thick layer of yellowish-gray plaque, plaque appears on the teeth and tongue, bad smell from the mouth. Salivation increases. Regional lymph nodes enlarged, painful. The period of exacerbation is 2-4 weeks. Erosion epithelializes after 7-12 days; after healing, no scars remain.

Painting peripheral blood during the period of exacerbation of exudative erythema multiforme, it corresponds to an acute inflammatory process.

Severity of the current exudative erythema multiforme is mainly due to the nature of the damage to the oral mucosa. The severe form is characterized by a pronounced hyperergic reaction of the body, as well as generalized damage to the mucous membranes of the mouth, eyes, genitals and skin.

In case mild course exudative erythema multiforme general condition patients does not change significantly; single lesions are detected on the oral mucosa. However, as the duration of the disease increases, its severity worsens. For exudative erythema multiforme of an infectious-allergic nature, a long, relapsing course is typical. Exacerbations of the disease are observed mainly in the autumn and spring periods (1-2 times a year), although there are known cases of more frequent exacerbations of the disease. Sometimes relapses can be triggered by hypothermia, past infections and other factors that weaken the body’s resistance. Exudative erythema multiforme lasts for years. During periods between exacerbations, there are no changes in the oral mucosa and skin.

Symptomatic (toxicoallergic) exudative erythema multiforme recurs only when the patient comes into contact with the etiological factor (drug-allergen).

Cytological examination of scrapings from the area of erosion reveals a picture of acute nonspecific inflammation.

Histologically, the subepithelial location of blisters is determined in exudative erythema multiforme. There are no signs of acantholysis. The rejected epithelium undergoes necrosis, in the underlying connective tissue swelling, inflammatory infiltration.

Diagnosis of Exudative erythema multiforme of the oral cavity

Exudative erythema multiforme is differentiated from:

acantholytic pemphigus;
nonacantholytic pemphigus;
acute herpetic stomatitis;
secondary syphilis.

Unlike acantholytic pemphigus, exudative erythema multiforme is characterized by acute course, polymorphism of lesion elements; expressed inflammatory phenomena; negative symptom Nikolsky; the absence of erosions in smears and prints from the surface and in the exudate of blisters of acantholytic cells.

Exudative erythema multiforme is distinguished from acute herpetic stomatitis by larger erosions that do not have polycyclic outlines, the absence of lesion elements in areas of the oral mucosa typical of herpetic stomatitis and multinucleated herpes cells in scrapings from the surface of erosions.

Acute course, severity inflammatory reaction oral mucosa, the seasonal recurrent nature of the course, in the intervals between which there are no signs of the disease, distinguishes exudative erythema multiforme from benign non-acantholytic pemphigus.

Mild course of exudative erythema multiforme may resemble eroded papules when secondary syphilis, at the base of which there is always infiltration. Hyperemia around syphilitic papules, including eroded ones, in the form of a narrow rim, sharply demarcated from the healthy mucous membrane. With exudative erythema multiforme, the hyperemia is extensive and diffuse. The soreness of syphilitic papules is mild; pale treponemas are found in scrapings from their surface; serological reactions positive for syphilis.

The toxicoallergic form of exudative erythema multiforme is diagnosed based on the medical history of taking medications, as well as the results immunological research in vitro (Selli basophil degranulation test, lymphocyte blast transformation test, cytopathological test) and cessation of exacerbation after discontinuation of the allergen drug. At skin rashes making a diagnosis is not difficult.

Treatment of exudative erythema multiforme of the oral cavity

IN acute period diseases are treated symptomatically, aimed at reducing intoxication of the body, desensitization, relieving inflammation and accelerating epithelization of the affected oral mucosa.

General treatment includes the prescription of desensitizing drugs: diphenhydramine, suprastin, tavegil, fenkarol, claritin, etc. Salicylates are used for anti-inflammatory therapy ( acetylsalicylic acid, sodium salicylate), calcium preparations (calcium gluconate, calcium glycerophosphate, etc.). For the same purpose, sodium thiosulfate is administered intravenously (10 ml of a 30% solution daily, for a course of 8-10 injections).

Be sure to prescribe B vitamins (B, B2, B6), ascorutin.

Exacerbation of exudative erythema multiforme is quickly relieved by ethacridine lactate (0.05 g 3 times a day for 10-20 days) in combination with levamisole (150 mg per day, 2 consecutive days a week, with 5-day breaks for 2 months) .

General treatment patients with severe course exudative erythema multiforme should be carried out in a hospital setting, where they are prescribed complex therapy- detoxifying, desensitizing, anti-inflammatory. In this case, corticosteroid drugs are usually used - prednisolone (30-60 mg per day in the initial dose). The drug at the indicated dose is taken for 5-7 days, then every 2-3 days the dose is reduced by 5 mg until the drug is completely discontinued. The initial dose of dexamethasone is 3-5 mg. Detoxifying and desensitizing therapy is carried out. Rheopolyglucin, hemodez, sodium thiosulfate, sodium hyposulfite, etc. are administered intravenously.

In the toxicoallergic form of exudative erythema multiforme, it is necessary to identify the causative allergen drug and stop taking it.

Local treatment is aimed at eliminating inflammation, swelling and accelerating the epithelization of the affected oral mucosa. Before medicinal treatment of the oral mucosa, it must be anesthetized with a 1-2% solution of t r and mecaine, 1-2% solution of pyromecaine, 1-2% solution of lidocaine. For application anesthesia anesthetics in aerosols Xylostesin, Lidocainspray, Anaesthesiespray, etc. are successfully used. In order to reduce pain, oral baths with a 1-2% trimecaine solution are prescribed before meals. Antiseptic treatment oral mucosa is carried out with 0.25-0.5% hydrogen peroxide solution, 0.25% chloramine solution, 0.02% chlorhexidine solution, 0.5% aethonium solution, etc.

For necrotic plaque on the surface of erosions, applications of proteolytic enzymes (trypsin, chymotrypsin, lysoamidase) are effective, after which keratoplastics (carotolin, rosehip and sea buckthorn oil, oil solution vitamins A, E, solcoseryl, solcoseryl dental adhesive paste, Actovegin).

Treatment of the oral mucosa during an exacerbation period must be carried out daily, and in the hospital - 2-3 times a day.

Skin lesions are usually special treatment not required. For itching and burning in the area of erythema on the skin, it is recommended to lubricate them with Castellani liquid or 2% salicylic alcohol.

For eye damage, use 0.5% hydrocortisone eye ointment, 0.1% dexamethasone solution.

An indispensable condition successful treatment patients with exudative erythema multiforme - identification and elimination of foci of chronic infection. During the period of remission of the disease, patients should be subjected to thorough examination and rehabilitation. In case of microbial sensitization, specific hyposensitizing therapy is carried out with allergens to which increased sensitivity. Effective in some cases repeat courses subcutaneous administration histaglobin (1-2 ml 2-3 times a week, only 8-10 injections per course), as well as anti-measles and antistaphylococcal gammaglobulin (5-7 injections per course of treatment).

Forecast

With exudative erythema multiforme, the prognosis for life is favorable and very serious with Stevens-Johnson syndrome.