Erythema multiforme exudative treatment with antibiotics. Features of the toxic-allergic form

Multiforme or multiform exudative erythema is an acute inflammatory process in the skin and/or, often in mucous membranes, characterized by a large number elements of a polymorphic rash, as well as a predominantly cyclical course and prone to both exacerbations and self-healing.

The disease occurs at any age, but most often among adolescents and young adults aged 18-21 years and in children after 5-6 years. The latter constitute on average 20% in relation to total number sick, although isolated cases have also been described in 2-year-old children. In 30% of cases the disease is recurrent.

Etiology and pathogenesis

There is no definitively proven unified theory about the causes and pathogenesis. Pathological process is considered polyetiological with a single development mechanism. However, the most popular assumption is that the causes of erythema multiforme are genetically determined changes in the immune system, leading to its hypersensitivity and inadequate response to the effects of certain external factors(antigens).

The implementation of immune hypersensitivity reaction mechanisms begins with damage to keratinocytes of the skin and/or mucous membranes by infectious (viruses, bacteria, fungi, etc.) or non-infectious ( medicines) origin. Regardless of the type of triggering factor (antigen) or their combination, the immune system perceives damaged cells as a protein foreign to the body and seeks to destroy or isolate it.

The principle of the response consists of a delayed (after several hours or days) type allergic reaction to one’s own damaged cells containing the antigen. This is manifested in the clinical picture of erythema multiforme, caused mainly by primary damage to small vessels and an increase in their permeability, impaired microcirculation and effusion of exudate (liquid part of the blood with cellular elements) into the layers of the dermis and mucous membranes. That is, there is development inflammatory process.

Classification of erythema multiforme

There are several conventional classifications based on the type of disease, the nature of the course and the main manifestations.

According to the type of implementing factor erythema multiforme differs as:

• or idiopathic. Ranges from 80 to 95%. It specifically highlights the Hebra type, or “small form,” which can be caused by viruses herpes simplex(about 80%), influenza, hepatitis, AIDS, as well as mycoplasma, rickettsial, fungal, protozoal and bacterial infections. Among bacterial infections main importance is given to beta-hemolytic streptococcus of group “A”, mycobacteria, Loeffler’s bacillus (the causative agent of diphtheria) and some others.
• Toxic-allergic, or symptomatic. Sometimes it is regarded (if it is impossible to establish a provoking factor) as an idiopathic, independent form. However, in the vast majority of cases it develops after the use of drugs that affect metabolic processes in the body - non-steroidal anti-inflammatory drugs, antibiotics, especially penicillin group, sulfonamide and antibacterial agents, synthetic vitamins and some others. In addition, quite often the starting substances are local anesthetics, anticonvulsant or antiepileptic drugs, in particular carbamazepine, barbiturates, vaccines and serums.

Depending on the severity of the patient’s condition and the severity of the main manifestations, two forms of erythema multiforme are distinguished:

• mild, occurring without significant disturbances in the general condition of the patient; with this form there are no lesions of the mucous membranes or they are very minor;
• severe, which is characterized by widespread skin rashes and mucosal lesions, accompanied by general disorders from mild malaise to severe and extremely severe general condition.

In accordance with the predominance of certain morphological elements rash, the following types of disease are distinguished:

• spotted;
• papular (papule is a formation on the skin without a cavity with a diameter of 1-20 mm);
• maculopapular;
• vesicular (from the word “vesicle”, a vesicle is an element with a diameter of 1.5-5 mm with serous or serous-hemorrhagic contents);
• bullous (from the word “bulla”, a bubble is a single- or multi-chamber formation with a diameter of 5 mm to 10 mm or more with serous or serous-hemorrhagic contents);
• vesiculobullous.

Due to effusion (exudation) in the tissue in the area of ​​the rash elements, the development of dermal and hypodermal edema, swelling of elastic and collagen fibers, abundant infiltration of tissue in the area of ​​dilated small vessels, as well as the formation of vesicles and blisters, the name “exudative erythema” is used as a synonym "multiform" or "erythema multiforme" (due to the variety primary elements). Very often these terms are used in combination.

Clinical manifestations

Infectious-allergic polymorphic exudative erythema

Prodromal period

The disease begins acutely, but only in approximately 16% of the rashes is preceded by prodromal symptoms clearly described by patients. It is characterized by signs of general intoxication of the body - severe weakness, dizziness and headache, pain in the joints and all muscles, loss of appetite, sleep disturbance, a sudden increase in body temperature to 38 ° -39 °, accompanied by chills, and often a sore throat during swallowing and other general symptoms.

Course of the disease

After 1-2 days, and sometimes on the 4th – 6th day from the onset of the first symptoms and over the course of 1.5 – 2 weeks, rashes appear on the skin “in a spurt” (repeatedly), after which the patient’s general condition improves somewhat .

The rash looks like small (1-2 mm) spots of bright pink color and rounded shape, slightly rising above the skin level due to an edematous ridge. They quickly increase in size and reach a diameter of 10-20 mm. Simultaneously with the spots, a nodular-papular rash of the same size and with clear outlines appears. The rashes do not tend to merge with each other and are accompanied by a burning sensation and (less often) itching.

After 1-2 days, spots and papules in the central part “sink” slightly and acquire a brownish or pale lilac-cyanotic tint, while their peripheral parts continue to increase somewhat and retain a bright pink color. Between these two zones there is a pale, raised corolla (the “cockade” symptom). Sometimes atypical elements are found.

In the cyanotic center, 1-2 new papules may appear, undergoing the same development and centrifugal increase, as a result of which the spot takes on the appearance of a “target.” Subsequently, an intraepidermal vesicle with a dense covering and opalescent liquid contents forms in the center of the papules or spots, and sometimes on their periphery or (rarely) a subepidermal blister with serous or serous-hemorrhagic contents.

If their walls are preserved, they shrink with the formation of bloody lamellar crusts in the center of the element. More often, a rapid rupture of the walls of the bladder occurs, exposing an easily vulnerable bleeding erosive surface, on which a fibrinous plaque forms, and then a bloody crust. Bubbles can also appear on unchanged skin and mucous membranes.

Localization of outbreaks

Characteristic of erythema multiforme is the strict symmetry of the location of the rash. The elements are localized mainly on the extensor surface of the forearms and the front surface of the legs, mainly in the area of ​​the elbow and knee joints, on the front surface of the feet and hands, especially on the back surface.

Less commonly, the rash appears on the palms and soles, and in these cases the latter acquire a diffuse bluish coloration. At the same time, fresh rashes appear on the shoulders and sometimes on the face (mainly in the area of ​​the red border of the lips), on the neck, on the skin of the chest, in the perineum and foreskin. Isolated cases of individual elements on the scalp have also been described.

Manifestations of exudative erythema multiforme on mucous membranes

With multimorphic exudative erythema, a rash can often appear on the mucous membranes oral cavity and genitals, sometimes even in isolation, that is, without skin rashes. The severity of the general condition is determined precisely by damage to the mucous membranes of the lips and oral cavity, where pathological elements are localized mainly on the tongue and diaphragm of the mouth, on the hard and soft palate. In some cases, erythema manifests itself only as small, slightly painful or painless limited foci of redness, which does not lead to discomfort.

But more often, isolated damage to the mucous membranes begins acutely without any previous symptoms. Localized or widespread areas of redness appear on them, against which characteristic blisters form after 1-2 days. The latter very quickly increase and rupture with the formation of a bleeding erosive surface.

The area of ​​erosions can increase, they tend to merge with each other, as a result of which the lesions spread over a significant area of ​​​​the mucosal surface, causing severe pain, which intensifies even more when eating and talking. In children, this leads to anxiety, refusal to eat and rapid dehydration of the body with the development of a serious condition.

Then, on the red border of the lips, the erosions become covered with a brownish fibrinous coating and brown bloody crusts, and in the oral cavity - only with a coating, when you try to remove it or as a result of accidental mechanical irritation, bleeding occurs. In case of attachment and development of a secondary infection, the crusts become dirty gray, the intensity of inflammatory processes and swelling of the soft tissues increases significantly.

Widespread exudative erythema multiforme in the oral cavity is accompanied, in addition to severe pain, increased salivation and difficulty in carrying out hygienic procedures, which contributes to the spread of inflammation to the mucous membrane of the gingival margin and the development of gingivitis. All this causes difficulty in taking even liquid food and significantly aggravates the general condition.

Resolution of the disease

The disease can last from 5 days to several weeks or longer. Resolution of all elements of the rash lasts on average 5-12 days. During this time, weakly expressed fine-plate peeling of the epidermis appears on the bluish background of the spots. The spots gradually fade and disappear, and in place of the blisters, lamellar crusts form, which then fall off. Pathological elements leave behind pigmentation of varying intensity.

Idiopathic erythema multiforme can occur with exacerbations. Relapses in most cases are characterized by seasonal cyclicity in the autumn-winter and early spring periods. This is due to the increase in the number of acute respiratory infections and exacerbation of infection in the body in areas of its chronic persistence (with chronic tonsillitis, sinusitis, rhinosinusitis, cholecystitis, pyelonephritis, etc.).

Features of the toxic-allergic form

Despite the fact that the symptomatic and idiopathic forms of exudative erythema multiforme occur with similar clinical patterns, there are many differences between them:

• Relapses of toxic-allergic erythema multiforme are not seasonal, but usually occur after taking appropriate medications, while, for example, herpes-associated erythema can recur every two months or even monthly, especially with hypothermia, decreased general immunity, mental stress and etc.
• If the foci of the rash are not widespread, but localized, then during exacerbations they always appear in the previous areas and may additionally appear in new ones, uncharacteristic of this disease.
• The symptomatic form, as a rule, is accompanied by a generalized spread of rashes in combination with damage to the mucous membranes. If the skin of the hands and feet is affected, then very often the palmar and plantar surfaces are simultaneously involved in the process.
• The spots are brighter in color compared to those in the idiopathic form of erythema multiforme, and blisters with a dense lid are much more likely to form on the face, on the unchanged surface of the skin and in the center of the “targets.” They are usually larger (up to 30 mm) and long time are not allowed. The appearance of blisters on the skin in places of friction with shoes or clothing is often noted, and they tend to merge, as a result of which they acquire an irregular shape.
• Localization on the mucosa is almost always found, which is probably due to their increased sensitivity to drugs and direct contact with the antigen at the time of its entry and removal of its metabolites from the body. In addition, very often there is damage to the mucous membranes of not only the oral cavity, but also the genital organs.

In some cases, in both forms, the height of the disease is accompanied by an abnormal temperature (increased in the morning and decreased in the evening), severe conjunctivitis, enlargement of the submandibular, axillary, and sometimes other groups of lymph nodes, and an enlarged spleen. Bullous forms of erythema multiforme are much more severe.

In toxic-allergic erythema, varieties are particularly distinguished - the so-called “large” forms:

1. Stevens-Johnson syndrome, or malignant exudative erythema.
2. Lyell's syndrome, or toxic epidermal necrolysis.

Stevens-Johnson syndrome

This variant of toxic-allergic erythema multiforme is a severe immunocomplex systemic allergic reaction, accompanied not only by lesions of the skin, but also the mucous membranes of at least two or more organs and occurring mainly in response to taking therapeutic doses of the drug, as well as as a result of the use of vaccines, serums.

Malignant exudative erythema usually affects people aged 20-40 years, and its frequency among men is 2 times higher. However, isolated cases have been described among children even at the age of three months. In 85% of cases, the disease begins with a prodromal period, which can last from one day to 2 weeks and is manifested by flu-like symptoms and (sometimes) vomiting and diarrhea.

Clinical picture

The clinical picture consists of symptoms of severe intoxication of the body and local manifestations. The severity of intoxication is expressed in constant high (up to 40 °) or hectic (with large “swings”) body temperature, in a decrease blood pressure and depressed, sometimes inadequate consciousness with symptoms of prostration.

On average, after 4-6 days from the onset of the disease, lesions of the skin and mucous membranes appear and rapidly develop. They are usually of a generalized nature with a predominant and densest distribution of rashes on the face, neck, extensor surfaces of the forearms, the front surface of the legs, the dorsum of the hands, the front surface of the feet, on the skin of the perineum, external genitalia and in the oral cavity.

The rashes are polymorphic and are represented by the elements described above, but the range of their sizes is much larger - in diameter they range from several millimeters to 5 cm. Large areas of the skin are affected with epidermal detachment over an area of ​​up to 10%.

Large blisters on the skin and lips develop and burst very quickly, and in their place thick crusts soaked in blood form. Large number small blisters appear on the mucous membranes of the cheeks, nasal passages, gums, hard and soft palate, on back wall throats.

They merge with each other, open up, forming extensive painful ulcerative and erosive surfaces, surrounded by a bright red rim up to 2 mm wide. At first they bleed profusely, and then become covered with a fairly thick necrotic gray-yellow crust that is difficult to remove. The skin around the lesions, lips, the area of ​​the wings of the nose, and mucous membranes are clearly hyperemic and swollen. All this leads to difficulty opening the mouth and the inability to swallow, to frequent nosebleeds and excessive salivation.

Damage to the mucous membranes of the eyes is manifested by bilateral vesicular conjunctivitis, and in more severe cases - keratoblepharitis, corneal ulcers, and iridocyclitis. As a result, it is possible in the future scar changes sclera and conjunctiva, astigmatism, severe keratitis with partial or complete (in 3% - 10% of cases) loss of vision, the formation of fusions between the eyelids or between the eyelid and the eyeball.

Involvement in the ulcerative process of the mucous membrane of the genital and urinary tract causes uterine bleeding, vulvovaginitis, hemorrhagic cystitis and urethritis, and can also lead to stricture (scar narrowing) of the urethra in men.

Sometimes cicatricial changes in the esophagus are possible with the development of its stenosis (narrowing), the development of proctitis, colitis, severe pneumonia and pulmonary edema, meningoencephalitis. The duration of the disease is 1-1.5 months or more. It is difficult to correct with therapy, can occur with relapses and, in severe cases, result in death (from 3 to 15%).

Lyell's syndrome

Epidermal necrolysis occurs in three stages (prodromal, critical and convalescent) and has much in common with erythema maligna exudativea. Many authors consider it to be its most severe variant.

The disease begins suddenly with a prodromal period ranging from a few hours to 1 to 3 days, or (often) without any prodromal symptoms. As a rule, this occurs 1-2 days after taking the drug.

Against the background of a general serious condition and a temperature of up to 40°, an erythematous-papular rash appears over a large area of ​​the skin surface. No specific localization of the rashes was noted, but more often the elements begin to appear on the face, the anterior and posterior surfaces of the chest and gradually descend to the lower half of the torso and limbs. Basically, ulcerative-necrotic rashes affect the skin, but in the case of a total process, a significant area of ​​​​the mucous membranes is also included.

Necrosis covers all layers of the skin. As a result of this, they peel off with the formation of bubbles, which soon open easily. Detachment of the epidermis in Lyell's syndrome no longer occurs on ten, as in the previous syndrome, but on more than 30% of the skin surface area.

After opening the blisters, significant necrotic areas are exposed, and the skin resembles one burned with boiling water - “a symptom of scalded skin”, or “a symptom of wet linen”. In these areas, abundant exudation (effusion) occurs, as a result of which significant volumes of fluid and protein are lost, severe intoxication and symptoms of a septic condition develop. In extremely severe cases, function is impaired respiratory tract, heart, liver and kidneys, pancreas and gastrointestinal tract, nervous system- multiple organ failure develops.

IN clinical course There are three variants of Lyell's syndrome:

1. Hyperacute, or malignant, fulminant, in which 80% to 90% of the skin surface is affected without involvement in the process internal organs. A secondary infection develops quickly, any treatment methods are ineffective, and death occurs within 2 to 3 days.
2. Acute - secondary infection and severe intoxication occur, the respiratory, cardiac and hepatorenal systems are affected, hemorrhagic necrosis of the adrenal glands occurs, etc. Fatal outcome possible during the period from the 4th to the 20th day of illness.
3. Favorable, in which, despite violations metabolic processes in the body and frequent infectious complications, in the period from the 5th to the 30th day of the disease the patient recovers.

The mortality rate for toxic epidermal necrolysis is 30%.

Treatment of exudative erythema multiforme

Exudative erythema multiforme is treated in a hospital setting. The treatment regimen is drawn up depending on the form and severity of the disease.

Diet

For any form, a hypoallergenic diet is prescribed, which includes exclusion from the diet:

• fruits, especially citrus fruits, and vegetables with orange and red colors, including tomatoes;
• eggplants and mushrooms;
• nuts;
• fish, especially red fish, and fish products;
• poultry meat and products made from it;
• smoked products, spicy and extractive products, including horseradish and radishes, pickles, mustard, marinades and spices;
• chocolate, honey, baked goods;
• coffee and alcoholic drinks.

Allowed use:

• wheat savory bread;
• lean boiled beef and soups with “second” beef broth;
• cereal and vegetable soups and porridges with the addition of vegetable or butter;
• one-day lactic acid products;
• fresh cucumbers, dill and parsley, watermelon and baked apples;
• compotes from fresh apples, cherries, plums and dried fruits;
• weakly brewed tea and sugar.

In case of damage to the oral cavity, use pureed and liquid dishes and drink plenty of fluids. If swallowing is impossible, parenteral nutrition is performed.

Drug therapy for exudative erythema

The infectious-allergic nature of erythema multiforme requires targeted examination to identify foci chronic infection and their treatment with antibacterial drugs and antibiotics wide range, and toxic-allergic - mandatory withdrawal of medications prescribed unreasonably, especially penicillin antibiotics, as well as other drugs that can provoke the pathology listed above.

Assumption about viral cause disease is the basis for prescribing antiviral and immunosuppressive drugs - Dapsone, Hydroxychlorine, Thyrolone or Azathioprine, and in cases of herpes-associated form of the disease - Farmavir, Acyclovir, Varaciclovir, Farmciclovir.

Immunomodulatory drugs (Tactivin, Staphylococcal toxoid, Pyrogenal, etc.) are possible only for “small” forms (Gebra type). Good immunomodulatory and antiviral effects has the drug Panavir.

Systemic treatment, in addition to antibiotics and antibacterial drugs, includes:

• antihistamines- Loratadine, Cetirizine, Levocetirizine, etc.;
• glucocorticosteroids (for moderate and severe cases) - Prednisolone, Dexamethasone, Metipred.

Local therapy

From external means local application for the treatment of erythema multiforme, aniline dyes are used to treat the erosive surface of the skin and blisters (Fukortsin, Methylene blue and Diamond green), emulsions, ointments or creams containing glucocorticoids (Methylprednisolone, Betamethasone, Hydrocortisone, as well as Adventan, Elokom, Celestoderm, Lokoid).

To treat secondary infection, combination ointments with corticosteroid and antibacterial or antifungal components (Belogent, Triderm, Pimafucort) are used. After the inflammatory processes subside, they are replaced by external preparations with a regenerating effect (Actovegin, Methyluracil ointment, Solcoseryl). Treatment of spots and papules is carried out by alternating glucocorticoid external preparations with creams that have nourishing and anti-inflammatory effects (Akriderm, Afloderm, Laticort).

In case of damage to the mucous membranes, careful brushing of teeth is recommended even in the presence of pain and erosion, rinsing and bathing with solutions of Miramistin or Chlorhexidine, using in alternating order antibacterial and promoting epithelialization balms, collagen plates for the oral cavity, gels (Acepta, Solcoseryl, Metrogil-denta, Cholisal , dental pastes).

In cases of severe intoxication and severe disease, long-term infusion therapy using electrolyte solutions, detoxification solutions, protein preparations, plasmapheresis, correction of vital function important organs etc.

Treatment of patients with Lyell's syndrome and malignant exudative erythema is indicated only in departments intensive care and resuscitation, treatment of the second is also possible and even desirable in a burn center.

Exudative erythema multiforme is an acute disease in which lesions appear on the surface of the skin or mucous membranes. The skin and mucous membranes can be affected together or separately, but in most cases these lesions are interrelated. Characteristic detection large quantity various elements of the lesion - the so-called polymorphic nature of the rash.

Exudative erythema multiforme is characterized by a recurrent course. There are periods of remission and exacerbation of the disease. The disease, as well as its exacerbations, most often develop in autumn and winter, i.e. the seasonality of the disease is characteristic.

Depending on the reasons that underlie the occurrence of exudative erythema multiforme, as well as exacerbations of the disease, it is customary to distinguish two forms of the disease: true - infectious allergic and toxic allergic forms of the disease.

For the second form special meaning has allergic reaction associated with infectious allergens. Highest value is given to the increased sensitivity of the human body to staphylococci. Also increased sensitivity may be associated with the impact on the human body of bacterial agents such as streptococci, Escherichia coli and many others. In some cases, there is evidence of increased sensitivity and the role of a number of viruses in the development of the disease, in particular herpes simplex viruses, Coxsackie viruses and ECHO. It is believed that viruses can also trigger disease development reactions, both due to the fact that they can lead to the development of infectious allergies in the body, and because when they influence the body, the body’s resistance levels decrease. Particularly important viral nature diseases have in weakened patients, patients old age.

In older people who have suffered for a long time viral diseases, there is prolonged contact with potential allergens, and therefore the risk of developing an infectious allergic form of exudative erythema multiforme increases.

Great value in the development of the infectious allergic form of exudative erythema multiforme is the presence of chronic diseases various organs and fabrics. The greatest role belongs to chronic inflammatory diseases nasopharynx, genitourinary system. Increased sensitivity to infectious agents develops due to their circulation in foci of chronic infection.

Here they reach fairly high concentrations. The relationship between the development of the disease and infectious allergies is confirmed to a certain extent, although indirectly, when conducting serological reactions. The most pronounced results of reactions are in those patients in whom frequent periods exacerbation of the disease, there are infectious diseases, especially in the acute phase.

In case of a decrease in the body's resistance, which can occur during hypothermia, stressful situations, colds, exposure to a number of provoking factors on the body, the development of the disease or its exacerbation is possible.

In patients with exudative erythema multiforme, the severity of symptoms of the disease in most cases correlates with the severity of autoimmune processes in the body. Patients with this form of the disease are extremely characterized by a decrease in the body's reactivity, often quite significant. This disorder is especially often detected during the period of exacerbation of the disease.

The facts that the disease with exudative erythema multiforme has a characteristic seasonal character, and the symptoms of the disease disappear spontaneously, as well as the fact that these patients had no previous allergic reactions, no symptoms characteristic of allergic diseases, indicate that the basis for the development of the disease is It’s not just the allergic factor. The toxic allergic form of the disease is often associated with increased sensitivity of the body to drugs belonging to the groups of non-steroidal anti-inflammatory drugs, sulfonamides, antibacterial drugs, barbiturates, etc.

The severity of erythema multiforme exudative disease can vary. The most severe variety of this disease Stevens-Johnson syndrome is considered.

Its development in most cases occurs after consumption medicines, belonging to the groups of sulfonamide drugs, antibacterial agents, non-steroidal anti-inflammatory drugs, anesthetics and some others. The occurrence of Stevens-Johnson syndrome is associated with intolerance to these drugs.

Peculiarities clinical picture exudative erythema multiforme
Infectious allergic form of exudative erythema multiforme
An acute onset of the disease is characteristic, when body temperature rises sharply and significantly (38 - 39 ° C), weakness appears, headache, dizziness, pain in joints and muscles, loss of appetite, sleep disturbances and other signs of intoxication of the body. After one to two days from the onset of the disease, characteristic lesions appear on the surface of the skin, having the appearance of a purple blue spots, which seem to rise above the surrounding skin. Their sizes range from 5 to 25 mm in diameter. The shape of the spots is most often round.

In most cases, after the appearance of rashes on the surface of the skin and mucous membranes, there is an improvement in the general condition of patients, a decrease in body temperature, and a decrease in intensity pain in muscles, joints, headaches. The location of the lesions is also characteristic. They are detected on the surface of the skin of the hands (especially the backs), on the forearms, on the legs, feet, neck, and face. In some cases, elements of the lesion may be noted only on the surface of the red border of the lips and on the skin and mucous membranes of the genital organs. Sometimes the entire surface of the skin and mucous membranes can be affected. The size of the spots increases very quickly. The appearance of blisters can also be noted on the unchanged surface of the skin and mucous membranes.

In most cases, the appearance of papules - nodules - is also noted on the surface of the skin and mucous membranes. They are round in shape and bluish-red or pink in color. Blisters may also appear on the surface of the papules. Quite quickly, the central sections of the papules sink and change color somewhat. The bluish tint of the central sections of the papules becomes more pronounced.

The peripheral sections do not change in color, but increase in size. In this way, lesion elements are formed, where the central areas are violet-bluish in color and sink, and the peripheral ones, in the form of a reddish rim, rise above the surrounding skin or mucous membrane. So-called cockades, or cockade-form elements, are formed. In these areas, the patient experiences a burning sensation and itching of the skin.

Subsequently, a subepidermal blister containing serous or hemorrhagic exudate may form in the center of the lesion. If the contents of the bubbles dry out, central departments crusts appear on the elements.

The mucous membrane of the oral cavity is affected. Its defeat mainly determines the severity of the disease. In the oral cavity, such areas as the red border and mucous membrane of the lips, the mucous membrane of the vestibule of the oral cavity, especially the cheeks, the mucous membrane of the floor of the mouth, and the palate are more affected. An acute onset of the process is characteristic, when a widespread or localized focus of redness of the mucous membrane is determined on the surface of the mucous membrane without previous signs. After 1–2 days, characteristic blisters form on the surface of the affected mucosa, which quickly burst with the formation of erosions in these areas. Erosions can increase in size and merge, leading to the formation of large affected areas of the mucous membrane. Erosions become covered with fibrinous plaque, bleed on their own or with mechanical irritation, when trying to remove fibrinous plaque from their surface. In the area of ​​some erosions, upon examination, altered areas of the epithelium of the covering of the former bladder may be detected. They have a whitish gray color. When pulling these areas of the epithelium with an instrument, no further detachment of the mucosal epithelium occurs, i.e. Nikolsky's symptom is negative. They cause the patient severe pain, which can be detected even in the absence of movement, and intensifies when talking, eating, or brushing teeth.

In some cases, exudative erythema multiforme may manifest itself only as isolated foci of redness on the surface of the mucosa, which cause virtually no discomfort to the patient or are mildly painful.

On the surface of the red border of the lips, blisters also quickly burst with the formation of erosions in these areas. Upon examination, you can often find fresh erosions and erosions, on the surface of which crusts are visible.

When infectious agents come into contact with erosive surfaces, secondary infection of wounds and the development of an inflammatory process may develop. In this case, the crusts change color and become dirty gray. If the damage to the oral mucosa is widespread, there is severe pain in the oral mucosa, a significant increase in salivation, and malnutrition (even difficulty in taking liquid food). This leads to even greater disruption of the patient’s general condition. The processes of cleaning the surface of the teeth are difficult, the hygienic condition of the oral cavity deteriorates significantly, and inflammatory lesions of the gingival margin often develop. This also has an extremely adverse effect on the development of the disease.

The healing time of lesions can vary, from 5–7 days to several weeks or more.

This form of exudative erythema multiforme is characterized by periods of exacerbation of the disease and remissions. The exacerbation of the disease in most cases occurs in the spring and autumn periods. Some patients may experience a so-called persistent course of the disease, when elements of the lesion are detected on the surface of the skin and mucous membranes almost constantly, persisting for months and several years. This course of the disease may be associated with constant exposure to various factors on the body, leading to a decrease in the body’s resistance.

Clinical manifestations of the toxic-allergic form of exudative erythema multiforme
The toxic allergic form of exudative erythema multiforme is similar to the infectious allergic form in terms of the nature of the lesion elements on the surface of the skin and mucous membranes. For toxic allergic form Diseases, unlike infectious-allergic diseases, almost always have a generalized nature of the rashes and there is damage to the oral mucosa. In the event that not widespread, but localized lesions are observed, with the development of an exacerbation of the process, lesions necessarily appear in the same areas as before; in addition, they can also be detected in uncharacteristic areas. In most cases, with the toxic-allergic form of exudative erythema multiforme, lesions of the oral mucosa are noted, which are the most characteristic. This is especially true for so-called fixed forms. This is due to the fact that the development of this form of the disease in most cases is associated with drugs that are administered orally, i.e. there is direct contact with the oral mucosa. In this regard, the oral mucosa has an increased sensitivity to drugs, which creates favorable conditions for the development of the toxic-allergic form of exudative erythema multiforme, in which elements of the lesion are often detected on the surface of the skin or mucous membrane, unchanged during external examination. The bubbles that appear in this case do not go away for a long time. Sometimes changes in the surface of the skin or mucous membrane occur after the blisters have turned into erosions. In most cases, changes in the mucous membrane of the oral cavity and facial skin in the toxic-allergic form are combined with lesions of the skin and mucous membranes of the genital organs, as well as the anus.

For the toxic-allergic form of the disease, there is no connection with the time of year. There is a relationship with the effect on the body of the provoking causal factor.

The more often the impact of such factors and the more pronounced changes in work immune system, the more often relapses of the disease occur and the more severe they are.

In most cases, the disease begins with general symptoms, when an increase in body temperature, malaise, weakness, lethargy, etc. appear, and then elements of damage to the mucous membranes and skin only appear.

Features of the diagnosis of exudative erythema multiforme
In the event that exudative erythema multiforme manifests itself only in the form of damage to the oral mucosa, its diagnosis is to a large extent difficult. This is due to the fact that this variant of the course of erythema multiforme has significant similarities with various other diseases of the oral mucosa.

The toxic allergic form of exudative erythema multiforme requires research aimed at determining the state of sensitization of the body to various substances with allergenic properties, in particular to drugs. It is of great importance to carry out immunological methods studies such as lymphocyte blastotransformation test, cytopathic effect, Shelley test for basophil degranulation. All three of these tests should be carried out due to the fact that the survey results obtained in this way will be more reliable and complete.

In the process of making a diagnosis, it is important to distinguish erythema multiforme exudative from diseases such as acute herpetic stomatitis, drug-induced stomatitis, pemphigus. Fixed forms of erythema multiforme may require differential diagnosis with syphilitic lesions of the oral mucosa.

Differential diagnosis of exudative erythema multiforme and syphilitic lesions of the oral cavity
There are several important differences between exudative erythema multiforme and syphilitic lesions of the oral mucosa
1. The presence of infiltration phenomena at the base of papules in syphilitic lesions of the oral mucosa, while this is not typical for exudative erythema multiforme.

2. With syphilitic lesions of the oral mucosa and with exudative erythema multiforme, the lesions of the mucous membrane are delimited from the unchanged mucosa by an inflammatory rim of hyperemia. With syphilitic lesions, this rim is quite narrow, the border between healthy and affected mucous membranes is visible. With exudative erythema multiforme, the rim of hyperemia is more widespread, which is associated with the most pronounced inflammatory process in the affected areas.

3. When taking scrapings from lesions with syphilitic lesions of the mucous membrane, the presence of syphilis pathogens - Treponema pallidum - is clearly determined.

For exudative erythema multiforme during this method diagnostics is characterized by the detection of cells of a nonspecific inflammatory process - neutrophils, lymphocytes, macrophages.

4. When conducting a blood test using the Wasserman reaction and RIF (immunofluorescence reaction) in patients with syphilitic lesions of the oral mucosa, the research data will be positive, in case of exudative erythema multiforme - negative.

Differential diagnosis of exudative erythema multiforme and acute herpetic stomatitis
General signs of exudative erythema multiforme and acute herpetic stomatitis
1. The presence of a prodromal period, i.e. a period of illness when clinical signs diseases have not yet appeared. With exudative erythema multiforme it averages 1–3 days, with acute herpetic stomatitis – 1–4 days. During this period there are general signs diseases. Both with exudative erythema multiforme and with acute herpetic stomatitis, there is an increase in body temperature to 38 - 40 ° C, there are signs of intoxication of the body in the form of headaches, dizziness, weakness, sleep disturbances and appetite, irritability, impaired performance, muscle pain and joints, etc.

2. There is some similarity in the elements of the lesion that are found on the surface of the oral mucosa. Both exudative erythema multiforme and acute herpetic stomatitis are characterized by the presence of blisters, erosions, and crusts. The mucous membrane of the oral cavity, skin, face, red border of the lips, mucous membranes of the nose, eyes, and genitals may be affected.

Distinctive signs of exudative erythema multiforme and acute herpetic stomatitis
1. With exudative erythema multiforme, especially with the infectious allergic form of the disease, in most cases the presence of concomitant diseases various organs and organ systems; This is not typical for acute herpetic stomatitis.

2. In most cases, exudative erythema multiforme is characterized by significant damage to the skin, which is not observed in acute herpetic stomatitis.

Characterized by the presence of specific cocardoform elements, papules. In acute herpetic stomatitis, a polycyclic form of erosion is observed.

3. Exudative erythema multiforme is characterized by true polymorphism of the elements of the rash, that is, various elements appear on the surface of the mucous membranes and skin at the same time. Acute herpetic stomatitis is characterized by false polymorphism, in which various elements of the lesion do not appear simultaneously, but as a result of the degeneration of one into another.

4. For exudative erythema multiforme, the following areas of location of the elements of the rash are most characteristic: the back surfaces of the hands, feet, forearm, lower leg, somewhat less often they are identified on the torso, face, neck. Damage to the mucous membrane of the oral cavity and genital organs is typical. Acute herpetic stomatitis is more characterized by damage to the perioral area, the red border of the lips and the oral mucosa.

5. In the oral cavity, with exudative erythema multiforme, the lips and the mucous membrane of the vestibule of the oral cavity are most often and to a greater extent affected. With acute herpetic stomatitis, there is no particular distribution of lesions on the mucous membrane; the presence of acute gingivitis is characteristic during almost the entire period of the disease.

6. The duration of preservation of lesion elements on the surface of the mucous membrane and skin in case of exudative erythema multiforme is on average

1 – 2 weeks. The duration of this period in acute herpetic stomatitis depends on the severity of the disease: from 1 - 2 days to a week or more (for mild severity - 1 - 2 days, for moderate severity - 2 - 4 days, for severe acute herpetic stomatitis stomatitis – a week or more).

7. In acute herpetic stomatitis, herpetic cells are identified in smears of impressions from the surface of the lesions.

Differential diagnosis of exudative erythema multiforme and drug-induced allergic stomatitis

General signs of exudative erythema multiforme and medicinal stomatitis

1. The development of the disease is related to the intake medicinal substance or medicinal substances.

2. There may be symptoms of a disease for which medications were prescribed that triggered the onset of the disease.

3. Elements of damage: spots, blisters, blisters, erosions, ulcers.

4. Damage to the mucous membranes and skin at the same time or damage to only the mucous membrane of the oral cavity is possible.

Differences between exudative erythema multiforme and drug-induced stomatitis
1. For allergies drug-induced stomatitis the patient often already has allergic diseases and allergic reactions to various substances. For erythema multiforme exudative allergy history in most cases it is not burdened.

2. Exudative erythema multiforme is characterized by a certain location of the lesion elements. For allergic drug-induced stomatitis, a specific location is not typical; the lesions are located on the entire surface of the body, mucous membranes, and may be located in fixed areas.

3. The duration of persistence of lesions on the surface of the skin and mucous membranes in erythema multiforme exudative varies from 5 days to several weeks or more; after discontinuation of the drug, the lesions do not disappear. In case of allergic drug stomatitis, the disappearance of lesions from the surface of the skin and mucous membranes is observed after stopping the use of the drug that provoked their appearance.

Differential diagnosis of exudative erythema multiforme and pemphigus

General signs of exudative erythema multiforme and pemphigus
1. Damage to mucous membranes and skin.
2. The appearance of spots, blisters, erosions, ulcers.
3. The general condition of patients in most cases is defined as severe or moderate.

Differences between erythema multiforme and pemphigus,
1. With pemphigus, the blisters are located intraepithelially, with exudative erythema multiforme - subepithelial. The small thickness of the tire in pemphigus leads to the fact that the presence of bubbles on the surface of the oral mucosa is practically impossible to visually trace - after an extremely short period of time after formation, the bubbles burst. With exudative erythema multiforme, a denser bladder cover allows them to be detected on the surface of the mucous membrane.

2. With pemphigus, unchanged mucosa is detected around the lesion. With exudative erythema multiforme, the bubble or erosion is surrounded by a fairly wide rim of hyperemia.

3. With pemphigus, a positive Nikolsky symptom is determined, which is negative with exudative erythema multiforme.

4. Cytological examination with pemphigus, it allows you to detect acantholytic Tzanck cells (cells of the altered surface layer of the epithelium, typical for pemphigus; they are small in size, have a large nucleus, usually consisting of several components). This is not typical for exudative erythema multiforme.

5. For pemphigus, specific results of the immunofluorescent method are determined.

General treatment of patients with the disease “erythema multiforme exudative”
Patients diagnosed with “erythema multiforme exudative” are subject to a thorough examination by specialists of various profiles in order to identify various types of chronic diseases and foci of infection that have been circulating in the body for a long time. It is important to examine patients for chronic odontogenic foci of infection.

Treatment of patients is carried out in accordance with the standards for the treatment of acute toxic and allergic reactions of the body. The dosage and regimen of administration of hormonal drugs may vary depending on the severity of the patient's condition. In the future, the drug is discontinued only after gradual decline doses.

Anti-inflammatory therapy is necessary. For this purpose, drugs such as sodium salicylate, sodium mefenaminate, acetylsalicylic acid and some others.

To influence the allergic component of the disease, it is necessary to prescribe desensitizing drugs. Suprastin, tavegil, diphenhydramine, fenkarol, kestin, loragexal, diprazine, histaglobulin, etc. can be prescribed.

In severe cases, antihistamine drugs are prescribed by injection.

In order to speed up the removal toxic substances detoxifying drugs are prescribed from the body, such as sodium thiosulfate, calcium gluconate, calcium chloride, various solutions electrolytes, plasma replacement, saline solutions, blood products and some other drugs.

An important component of treatment is vitamin therapy. The most important vitamins are B vitamins. ascorbic acid, nicotinic acid. In the event that patients are elderly, weakened, as well as when sharp decline indicators of immunity, in case of development of purulent inflammatory complications the prescription of antibacterial drugs is made in accordance with the sensitivity of the bacterial flora to them, which is activated under conditions of the disease. Prescribed drugs of the penicillin group (ampicillin, ampiox, oxacillin sodium, etc.), lincomycin, gentamicin, macrolides, etc.

Depending on the disturbances in the functioning of various organs and organ systems, drugs with antiplatelet, anticoagulant effects, diuretics, cardiac glycosides, and drugs with a sedative effect are prescribed.

If blood circulation indicators are in a stable state, other methods of detoxification of the body can also be prescribed - plasmapheresis, hemosorption, hemodialysis.

After treatment, in most cases, further correction of dysbiosis is required with the prescription of special medications - eubiotics, various enzyme preparations.

In severe cases of the disease, with pronounced symptoms of the disease, the patient should receive inpatient treatment. In severe cases, the duration of treatment for a patient in a hospital can be two months or more.

The nutrition of patients with exudative erythema multiforme should be special. Food should be of liquid consistency and not irritate the damaged oral mucosa. Avoid salt, pepper, sour foods, carbonated and alcoholic drinks etc. Food must be sufficiently high in calories, contain proteins, fats and carbohydrates in the required ratio, be complete and balanced, which is extremely important for the weakened body of the patient. Also, the diet should not contain those foods that are potential allergens or cause allergic reactions in the patient.

During the period when there are no symptoms of the disease, a number of measures are also necessary. This need is dictated by the fact that erythema multiforme is a disease characterized by relapses, which are quite frequent in many patients. In this regard, it is extremely important to take measures to remove toxic substances from the body. For this purpose they use staphylococcal toxoid. Measures to cleanse the blood of harmful toxic substances, taking medications such as fenkarol, histaglobulin, asparkam, levamisole, and carrying out physiotherapeutic measures (such as intravenous laser, plasmapheresis, etc.) are indicated.

Important points are thorough sanitation of the patient’s oral cavity, identification of carious teeth, foci of infection in the dental pulp, periodontal tissues, periodontium, and their treatment.

Local treatment of patients with the disease "exudative erythema multiforme"
With exudative erythema multiforme, along with general treatment It is extremely important to carry out local treatment of damaged areas of the skin and oral mucosa.

Due to the fact that the affected areas of the mucous membrane and skin are painful, they should be anesthetized before further treatment. The anesthetic solution can be used in the form of oral baths (a weak anesthetic solution is introduced into the oral cavity and kept in it until the swallowing movement appears, after which it is evacuated). Applications of anesthetic solutions to the surface of the oral mucosa and skin can also be used.

After anesthetizing the lesions, they should be treated with an antiseptic solution. To do this, use hydrogen peroxide (1% solution), a weak solution of potassium permanganate (1: 5000), chloramine (0.25% solution), chlorhexidine (0.06% solution), furatsilin (0.2% solution ), etc.

Antiseptics can be used plant origin. Antiseptics are necessary to ensure that the action of opportunistic microbial agents in the lesion does not lead to the development of a secondary inflammatory process in this area.

After antiseptic treatment of the oral cavity, local anti-inflammatory measures should be taken. Hormonal medications can be used for this purpose. local action, containing corticosteroids as active components.

Applications to the surface of the oral mucosa of hydrocortisone and prednisolone ointments, ointments flucinar, lacocorten, lorinden, etc. are used. They have an anti-inflammatory effect on the affected areas, reduce the permeability of vascular structures in these areas, reduce swelling, and activate normal course metabolic processes.

With the appearance of the first signs of healing of the lesions, epithelializing drugs begin to be used. To speed up the healing process of affected areas, medications such as vitamin A in oil solution, sea buckthorn oil, rosehip oil, carotoline, solcoseryl in ointment or gel, methyluracil, actovegin, acemin, Unna paste and some other drugs are widely used.

They change the direction of metabolic processes in the affected areas, which promotes the most favorable and rapid healing.

In the event that the presence of plaque from dead tissue is determined on the surface of damaged areas of the oral mucosa, first mechanical and then chemical cleaning mucous membrane. Mechanical cleansing of the affected areas is carried out using dental instruments, for chemical purification it is necessary to use drugs from the group of proteolytic enzymes. Trypsin, chymotrypsin, immozymase, lysozyme, ribonuclease, deoxyribonuclease, etc. are used. Wipes are moistened in a solution of these enzymes, which are then placed on the affected areas.

Physiotherapeutic activities in complex treatment exudative erythema multiforme
IN lately Physiotherapeutic treatment methods are widely used for the treatment of exudative erythema multiforme. It is possible to carry out CUV irradiation, laser therapy using a helium-neon laser, and hyperbaric oxygenation. These physical therapy treatments aim to provide more fast healing lesions, increasing the resistance of both the body as a whole and the skin and mucous membranes. Physiotherapeutic measures lead to changes in the course of metabolic processes in the body and in the affected areas, to accelerate the healing of wound surfaces, and have an anti-inflammatory effect.

Exudative erythema multiforme (EME) is a skin disease of inflammatory-allergic nature. The mechanism of skin damage is based on the mechanism of autoimmune reactions of type 3 (Arthus reaction).

Symptoms of exudative erythema multiforme

Exudative erythema multiforme has the following symptoms: fever up to 38.00 C, aches in the muscles and joints, headache, the appearance of small blisters on the mucous membrane of the cheeks and lips in the area of ​​​​washing the teeth, on the hard and soft palate, under the tongue. The blisters quickly burst, turning into painful erosions covered with a white coating. A distinctive feature of erosions in MEE is that they occur against the background of an apparently healthy mucous membrane.

Erosion appears on the lips, covered with brown crusts, which makes it difficult to open the mouth and eat food.

On the hands, legs, forearms, and less commonly, bluish-red spots appear on the face and neck, protruding above the surface of unchanged skin. Their center seems to fall inward. After 1-2 days, bubbles with transparent or purulent contents appear in the center of the spot, which burst with the appearance of erosion covered with a black-brown crust. The rash looks like cockades.

Exacerbations of the disease occur approximately 1-2 times a year (more often in the spring-autumn period), and last 2-4 weeks.

What manifestations does the doctor note?

Making a diagnosis is usually not difficult. During the examination, the doctor pays attention to: Location of the rash: oral mucosa, skin of the hands, legs and forearms, red border of the lips. Type of rash: “cockades” on the skin, crusts on the lips, erosions on the mucous membrane. Negative Nikolsky's symptom: when pulling on fragments of bubbles along the edges of erosions in the mouth, the unchanged mucous membrane does not exfoliate. The appearance of erosions on the mucous membranes over apparently healthy tissues.

Differential diagnosis

Erythema multiforme should be distinguished from diseases with similar manifestations:

• Acantholytic (true) pemphigus. It is characterized by:
  • The appearance of bubbles on the upper body, shoulders;
  • homogeneity of rashes (rash in the form of bubbles, erosion);
  • sharply positive Nikolsky symptom;
  • cytology: acanthosis, spongiosis, dystrophy of the spinous layer; Tzanck cells;
  • the appearance of blisters on the skin without visible redness.
• Nonacantholytic pemphigus. It is characterized by:
  • The appearance of a rash only on the oral mucosa;
  • the bubbles have a thick cover and last a long time;
  • usually not accompanied by fever;
  • negative Nikolsky sign.
• Acute herpetic stomatitis, which:
  • Appears only during the initial infection (at 1-4 years of age in children);
  • the rash appears in the form of bubbles with transparent contents on the skin of the lips and mucous at the site of the passage of nerve branches (more often along the line of closure of the teeth and never on the hard palate);
  • body temperature rises to 39.50 C in severe forms;
  Nikolsky's symptom is negative;
• cytology: multinucleated cells;
• accompanied by severe pain, drooling, enlargement lymph nodes under the lower jaw.
• bubbles and erosions form on the reddened mucosa.

Secondary syphilis, which manifests itself:

• Spotted, nodular and, less commonly, pustular rash on the genitals, upper half of the body, back;
• painless enlargement and hardening of all lymph nodes (scleradenia);
• damage to the mucous membrane of the tongue (back and side surfaces), hard and soft palate, painlessness of ulcers and erosions in the mouth;
• compaction at the base of erosions and ulcers;
• in smears from erosions and ulcers - treponema pallidum, positive Wasserman reaction (WRT).

Stevens-Johnson syndrome

More often it occurs as a result of allergies to medications. It has a more severe course than exudative erythema multiforme: in addition to the oral mucosa, the mucous membranes of the genital organs (vulvovaginitis, urethritis), nasal cavity and eyes (uveitis) are affected. Body temperature rises to 38.50C, painful compaction of the submandibular lymph nodes appears.

Causes of exudative erythema multiforme

It is not known for certain what causes this disease. But today there are two main theories of its development:

• Infectious-allergic- as an allergic reaction to microbes in chronic diseases (pyelonephritis, chronic diseases ENT organs, caries and its complications, gum disease). Differs more light current and occurs in 93% of cases;
• Toxic-allergic- as a reaction to the administration of drugs. Has severe course(Stevens-Johnson syndrome) and occurs in 7% of cases. Distinctive feature- exacerbation is provoked by taking a certain medication (most often non-steroidal anti-inflammatory drugs).

Treatment of exudative erythema multiforme

Therapy for exudative erythema multiforme is carried out comprehensively. The patient receives the main treatment from a dermatovenerologist, and the symptoms of the disease are alleviated through special oral care performed by the dentist. Drugs that are used to achieve remission are divided into general and local therapy.

General therapy of erythema multiforme

Treatment is prescribed by a dermatovenerologist:

• Identification of chronic foci in the body: consultation with an otorhinolaryngologist, nephrologist, gastroenterologist, gynecologist, immunologist, etc. and treatment of detected chronic diseases.
• When an allergen is identified - specific treatment: administration of small doses of the allergen that do not provoke a reaction (1:32000, 1:64000) every 3-4 days, gradually increasing the dose.
• Nonspecific antiallergic treatment: antihistamines (loratadine, diazolin, allergodil, fenkarol, edem, claritin, tinset) and calcium preparations (calcium gluconate 0.5 g 3-4 times a day).
• Severe cases require the prescription of glucocorticosteroids: prednisolone, dexamethasone or triamcinolone 30 mg/day for 5-7 days.
• Prescription of immunocorrectors: lysozyme 100-150 mg twice a day; decaris 150 mg/day in the first three days of illness; thymulin, immunal, groprinosin.
• Broad-spectrum antibiotics.
• Multivitamins (mainly group B - B1, B2, B5, B6, B12, PP).

Local treatment

It is performed by a dentist. The main task of local treatment of manifestations on the oral mucosa is to remove plaque from erosions to reduce intoxication of the body and prevent infection of erosions. Local treatment includes:

• Treatment of erosions with a solution of proteolytic enzymes (trypsin, chemotrypsin, hyaluronidase, collagenase, DNAase) is carried out in the doctor’s office with a freshly prepared enzyme solution every other day;
• Rinsing the mouth with an antiseptic (chlorhexidine bigluconate 0.05% solution, furatsilin solution 1:5000) - 5-6 times a day;
• To relieve pain before meals: 10 minutes before meals three times a day - Cholisal-gel, a mash with anesthetic in peach oil;
• To prevent suppuration of wounds: Metrogil-denta gel, Iruksol (three times a day after meals);
• Improving tissue immunity in the oral cavity: Solcoseryl-gel, Imudon (2 times a day under the tongue);
• Relieving inflammation: Etonia ointment 5%, Mephenate ointment, 2% prednisolone ointment (or hydrocortisone) - apply to the damaged mucosa three times a day after eating and rinsing for 10 minutes;
• Accelerating the healing of erosions - oil solutions vitamins A and E, rosehip oil.

The term “erythema” unites a large group of skin diseases accompanied by a pronounced rush of blood to the capillary vessels. Exudative multiforme is called erythema, which is characterized by 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 designate 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.

Read more about the causes of allergies

The photo shows polymorphic exudative erythema, the development of which was probably facilitated by previous focal infections. The category of such infections includes tonsillitis, appendicitis chronic form, sinusitis, pulpitis.

Read more about the causes of toxic-allergic erythema

This type of exudative erythema in the photo develops, as a rule, due to individual intolerance medicines. The presence of malignant processes in the body also plays a role in the development of this form of the disease.

Other reasons

Along with other factors, hypersensitivity to the activity of staphylococcus, streptococcus, coli.

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 of how to treat a strange condition in patients with exudative erythema multiforme usually arises 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.