Drug-induced stomatitis. Preparations for cauterization of ulcers

Specific rashes on the mucous membrane oral cavity, spots, blisters, swelling - all this can be a consequence of the use potent drug. Moreover, sometimes it doesn’t even matter whether you ingested it or simply used it for contact treatment. Unfortunately, there is no classification and it is impossible to predict in advance what reaction the body will give to the medicine. The processes are so individual that one person may undergo treatment without visible complications, another will develop only mild urticaria, and a third will suffer from serious skin reactions, erosions and painful ulcers, up to Quincke's edema.

Idiosyncrasy or violent reaction of the body to contact with foreign substances, including strong medications, a frequent phenomenon, since most antibiotics cause an allergic reaction, and therefore doctors always prescribe them along with antihistamines. In addition to drug-induced stomatitis, such patients may develop skin irritations, eczema, allergic sinusitis, headaches and even asthma attacks.

In addition, the general condition worsens, weakness, nausea appear, and a low-grade fever that does not subside may appear. The presence of all these signs or at least one or two of them (after taking a potent drug) in parallel with stomatitis clearly indicates its drug origin.

Depending on the degree of resistance of the body and its susceptibility to medications, such a reaction can last from a couple of hours to several days. And if external skin manifestations Allergies may go away quickly, but treating stomatitis will require some tinkering.

Most often, stomatitis occurs when taking medications orally, however, it can also occur as a result of contact with low-quality prosthetic or filling material. In this case, the reaction will only be local.

The type of stomatitis can be identified by laboratory conditions by donating blood for analysis. Drug intoxication organism is confirmed by the presence in the blood high content taken drug. Let's look at which medications can cause certain reactions.

Reasons for education

An unusual reaction of the body can develop to any, even seemingly harmless, medications, but most often stomatitis occurs while taking drugs such as:

antibiotics (tetracycline, streptomycin);
anesthetics;
sulfonamides (sulfidine, norsulfazole, sulfazole, streptocide, etazol);
pyrazolone drugs (analgin, antipyrine, butadione, amidopyrine);
enzymes;
serums and vaccines;
barbiturates;
vitamin complexes;
phenol;
bromine;
arsenic;
salt heavy metals(lead, mercury, bismuth).

Moreover, reactions most often occur to sulfonamides and antibiotics, but stomatitis may also occur due to taking other, more specific medications.

And if an acute reaction to the first dose of the drug can occur either immediately or within a short period of time, then after repeated administration a persistent allergic reaction develops. So, for example, the reaction to initial appointment sulfonamides may occur within three days. But an allergy to antibiotics can occur not only immediately, but also develop gradually, with a cumulative effect while taking the prescribed course.

To avoid such an allergic reaction, before starting long-term use or the introduction of a large dose of the drug, it is necessary to conduct a test that will show whether the body tolerates it normally this medicine. If you haven’t done the test and you start to have stomatitis, the following list of symptoms will help you determine whether it is medicated or not.

Symptoms, complications and clinical picture

The manifestation of drug-induced stomatitis is individual not only for each drug, but also for each person. The big picture the disease is characterized painful sensations, itching, burning, swelling, malaise, impaired salivation, dry mouth and the appearance of rashes that are not characteristic of the body’s usual state.

Stomatitis may occur after taking antibiotics next row signs:

Redness and severe swelling of soft tissues (lips, cheeks, tongue) and palate.
Bleeding and increased soreness of the gums when touched.
The tongue becomes smooth and swollen, the oral mucosa is dry and sensitive to external irritants.
In parallel, headaches, joint pain and swelling, muscle pain, urticaria, itching, and low-grade fever may appear.
IN difficult cases possible occurrence anaphylactic shock.

Taking sulfonamide may be accompanied by uneven redness with the further appearance of single or multiple spots of intense red-blue color, blisters, after rupture of which a long-term, non-healing erosion is formed. The rash can spread not only to the oral mucosa, but also to the facial skin around the lips. At the same time, the drying crusts crack painfully when you try to open your mouth.

Iodine and bromine also cause severe reaction in some patients, accompanied severe swelling, pain in the gums, profuse salivation And allergic rhinitis. Granulomas, blisters and iodine acne appear on the mucous membrane and skin, and the work of the glands is activated.

One of possible reasons development of medicinal stomatitis - dysbacteriosis due to long-term use antibacterial drugs , hormones, cytostatics and sulfonamides. In this case, the consequences will be not only stomatitis, but also a rash and blackening of the tongue with a change in its texture.

The very first step in the treatment of this type of stomatitis is discontinuation of the drug and complete cleansing body from an allergen. Further actions depend on the severity of the disease and consequences. Rashes are being treated antiseptic solutions, A drug therapy Most often this means taking the following medications:

diphenhydramine;
calcium chloride;
pipolfen;
a weak solution of adrenaline subcutaneously;
suprastin (tavegil).

Erosion is treated with retinol acetate for speedy healing. To restore the immune response, vitamin C is prescribed if the allergy was not to it. Frequent rinsing with sodium bicarbonate solution is also recommended. Within a few days obvious symptoms stomatitis disappears with this treatment.

Fixed medicinal stomatitis

This type of stomatitis is characterized by the appearance of single or multiple spots with a diameter of up to one and a half centimeters. In fact, it is also an allergic reaction to taking tetracycline, barbiturates and sulfonamides, but it is usually classified as a separate subspecies.

In the center of each spot or group of spots, a vesicle with serous fluid is formed, which opens almost immediately after its appearance. When you take the drug that caused the reaction a second time, a bubble will appear in the same place. In addition to the appearance of rashes on the oral mucosa, the same blisters can form on the genitals, and their appearance will be characterized by severe itching and burning.

As a result of the occurrence of fixed drug-induced stomatitis, it becomes painful for the patient to open his mouth and eat, which can lead to weight loss, exhaustion and a decrease in the body’s overall resistance.

The only treatment in this case is drug withdrawal, causing a reaction, and the prescription of antihistamines. Local symptoms are relieved by regular rinsing and applications.

Stomatitis is inflammatory process mucous membranes, which is accompanied by the appearance of ulcers on inside cheeks and lips. Stomatitis is accompanied copious discharge saliva, swelling, loss of taste.

It has always been believed that stomatitis is a childhood disease, which often accompanies scarlet fever, diphtheria or measles. However Stomatitis develops independently in adults, which is associated with an imbalance in the flora of the oral cavity. This happens for a number of reasons, the main one of which is related to decreased immunity.

For effective treatment stomatitis in the mouth in adults is necessary A complex approach, including eliminating symptoms, causes, strengthening the immune system

Stomatitis in adults creates discomfort in the mouth and a feeling of discomfort. In this case, treatment is carried out by a set of measures: stomatitis cannot be cured quickly only by taking antibiotics.

There are several types of stomatitis. For example, they distinguish aphthous, allergic, herpetic, catarrhal stomatitis.

Regardless of the type of disease, drugs containing anti-inflammatory and analgesic components are used.

A number of therapeutic measures are also used in treatment. The main recommendations for the treatment of stomatitis, depending on the type, are presented in the table:

Stomatitis in the mouth in adults
View	Treatment
Catarrhal	Disinfection of the oral cavity, use of local anesthetics and antiseptics
Herpetic	Reception antiviral drugs. After hiding the ulcers, antiseptic and healing ointments are used
Allergic	Eliminating the allergen, following a diet (do not eat foods that irritate the mucous membrane - smoked meats, pickles, acids, sweets). Use of ointments and rinses
Aphthous	A set of measures aimed at general increase human immunity. The use of healing ointments

Painkillers, antiseptics for stomatitis

Oral stomatitis in adults is accompanied by pain and burning, which makes eating difficult. Therefore, treatment of any type of stomatitis often begins with the use of local anesthetics and antiseptics.

Hexoral Tabs

The drug is presented in the form of tablets for slow resorption.

The active ingredients of Hexoral Tabs are benzocaine and chlorhexidine, which provide pain relief and antiseptic effect on the affected areas of the oral cavity.

Hexoral is also produced in the form of an aerosol, which contains hexethidine, which fights bacteria. The aerosol must be used 3 times a day.

Kamistad

It is a gel natural basis. Gel at local application relieves unpleasant and painful sensations, effectively fights bacteria.

The gel smells pleasantly of chamomile. Adults can use Kamistad without restrictions, as needed, but not more than 5-6 times a day(Rub into affected areas).

Note! The drug contains benzalkonium chloride, an antiseptic that stimulates the deposits of iron salts on the teeth. After using Kamistad, black spots form on the tooth enamel, which can be removed by professional cleaning dentist

Instillagel

The gel contains lidocaine and chlorhexidine and is used as a local anesthetic.

A drop of gel is completely rubbed into the affected areas of the oral mucosa.

The drug has contraindications in the form of pregnancy in the first trimester and lactation.

During these periods, the gel is used only when absolutely necessary (consultation with a doctor is important).

Antimicrobial, anti-inflammatory medications for stomatitis

At bacterial stomatitis, drugs are used to help fight microbes and inflammatory processes. Complex drugs restore the optimal balance of microflora and heal wounds of the oral mucosa.

Lugol spray

It is an aerosol that is used 4-6 times a day. The spray should be sprayed pointwise, with one click. The aerosol is not recommended to be swallowed. If a significant portion of the spray gets inside, you should consult a doctor.

The active ingredients of the aerosol are potassium iodide and glycerol. Molecular iodine in the spray is effective in combating bacteria and fungi.

The average cost of the drug is 120 rubles.

Contraindications for the use of the spray include:

pregnancy;
lactation;
chronic liver and kidney diseases;
dermatitis herpetiformis;
thyrotoxicosis.

Be careful! In case of overdose, it is possible to burn the mucous membranes of the cheeks and lips. You should strictly follow the instructions and use the medication as directed.

Vinylin

A complex drug that fights microorganisms and has an anti-inflammatory effect, promoting the regeneration of mucosal tissue.

Vinylin is presented in the form of a viscous balm (also known as Shostakovsky's balm), which is rubbed into the lesions using a cotton swab. The balm is applied before bed and after meals 3 times a day.

Miramistin

Represents ready solution for rinsing. Treatment must be carried out within 7 days.

Rinsing should be done at regular intervals 4 times a day. It is recommended to carry out the procedure after eating.

When the solution comes into contact with the oral mucosa, a slight burning sensation may be felt.

The average price of the drug is 220 rubles.

Healing remedies for stomatitis

Special ointments and tonics are successfully used as healing agents for oral stomatitis in adults. General recommendations for treatment:

apply the ointment to the affected areas (ulcers) using a cotton pad or cotton swab;
repeat the treatment procedure every 3 hours;
do not swallow the ointment orally (do not eat after the procedure);
For stomatitis on the tonsils, it is recommended to use a syringe with a convenient attachment for applying ointment.

Solcoseryl ointment effectively heals stomatitis. ethnoscience recommends using sea buckthorn oil as an ointment. The drug Imudon, which must be slowly dissolved, also fights ulcers.

Solcoseryl

Due to its oily base, the ointment does not stick to the wet side of the cheeks, so Solcoseryl is used to treat stomatitis on the inside of the lips, as well as damage to the facial skin.

Solcoseryl is available in the form of ointment and gel. The ointment is used for stomatitis in adults only for the treatment of dried ulcers in the mouth, and the gel is used for the treatment of wet wounds.

For effective healing mouth ulcers, the gel is first applied, and after the wounds have crusted over, they are treated with ointment. Solcoseryl is available in 20 g tubes. The price of the ointment is approximately 250 rubles.

Imudon

The drug is a lozenge containing a mixture of bacterial lysates. Bacteria stimulate growth immune cells, activate phagocytosis (the process of capturing foreign particles and microorganisms), which promotes rapid healing of wounds.

Imudon is used 6 tablets per day (every 2 hours). Treatment course is 10 days. The price of the drug is 400-600 rubles.

Sea buckthorn oil

Sea buckthorn oil regenerates damaged tissue, therefore it is effectively used for stomatitis to heal ulcers.

Painful areas of the mucous membrane are lubricated with oil (applied cotton swab) after meals 3-4 times a day. As alternative remedy Rosehip oil can be used.

Antiviral drugs for stomatitis

Viral stomatitis is most often caused by the herpes virus. Anti-inflammatory and healing drugs are not enough in this case. It is necessary to eliminate the cause of stomatitis – the virus. Ointments are used effectively for this.

It is important to know! Viral stomatitis in the mouth of adults should not be started: treatment must begin immediately when the first symptoms are detected. Advanced herpetic stomatitis develops into chronic form and manifests itself not only in the oral cavity, but also on other organs.

Oxolinic ointment

An antiviral ointment that successfully fights herpes contains an active antiviral substance - oxolin. Apply the ointment 2-3 times a day to the affected areas, wounds and ulcers.

Oxolinic ointment is an ideal remedy in the fight against stomatitis. The ointment does not have side effects and can be used by both adults and children.

Acyclovir ointment

The ointment effectively fights all forms of herpes, including viral stomatitis. The ointment is rubbed into the affected tissue every 4 hours.

Depending on the manufacturer, dosages, forms and volumes, the ointment can cost from 15 to 400 rubles. It has analogues: Acigerpin, Herperax, Vivorax, Zovirax.

Viru-merz-Serol

The drug is presented in the form of a gel, which is applied to the affected areas of the skin. Contains the active substance tromantadine, which not only fights viruses, but also relieves itching, pain, and swelling. The gel helps reduce treatment time.

Apply 3-5 times a day on ulcers (treatment stops if blisters form). The treatment course is 5 days.

Antifungal agents for stomatitis

After a course of antibiotics, there is often a decrease in immunity and the growth of Candida fungi, which can cause stomatitis in the mouth in adults. Treatment in this case involves the use of local antifungal agents in the form of ointments.

Candide

The ointment effectively fights not only fungal stomatitis, but also other types fungal infection fabrics(lichen, erosion, candidiasis, etc.). Contains the active substance clotrimazole, which can be used as tradename ointments.

Also available in powder or lotion form. Apply 2-3 times a day. The ointment is applied to ulcers and wounds.

Mycozon

Another name is Miconazole. Used to combat fungal diseases. For stomatitis, apply (rubbed) onto the affected areas of the oral mucosa 2 times a day.

Pimafucin

It is a cream with active substance natamycin. Refers to antibiotics wide range antifungal action. Before using the cream, it is recommended to consult a doctor.

Depending on the development of stomatitis, it can be used 1-4 times a day. The cream is rubbed into the affected areas of the oral mucosa.

Stomatitis is an unpleasant disease that must be dealt with immediately at the first symptoms. Stomatitis can be cured on its own within 7-10 days. If stomatitis occurs frequently, it is recommended to consult a doctor.

Causes and treatment aphthous stomatitis in the mouth of adults:

Symptoms and treatment of herpetic stomatitis:

- This inflammatory disease oral mucosa, developing as a result of an allergic reaction after using medications. Pathological process characterized various changes from the mucous membrane: swelling, the appearance of spots, blisters, erosions, etc. In diagnosis crucial have data allergy history and allergy tests. Treatment of the disease begins with eliminating contact with the allergen, and then, based on the specific clinical case, use oral and topical forms of medications.

General information

Drug stomatitis is an allergic reaction of the oral mucosa to taking any medication, manifested by inflammatory changes and the appearance of rashes. Moreover, the reaction to the same drug in different patients may differ radically, so it is difficult to talk about characteristic clinical picture. The disease occurs among patients of all ages, but young people and children are more likely to be affected. It is important to note that drug-induced stomatitis forms only with repeated contact with medicine usually when taken orally. Stomatitis may not be the only manifestation of sensitization - so, along with changes in the oral mucosa, the development of any other allergic diseases up to anaphylactic shock and Quincke's edema. This fact requires a particularly attentive attitude of the dentist to the patient with drug-induced stomatitis.

Causes of medicinal stomatitis

Any drug can be a trigger for the development of the disease. Under certain conditions, its entry into the body causes a form of immune response accompanied by pathological changes from the oral mucosa. Other mucous membranes may also be involved in the process, skin And internal organs. After the first contact with the allergen, a latent period begins, lasting from 10 to 20 days. At this time, antibodies are synthesized, which are responsible for the formation of an allergic reaction to subsequent contact with the drug. Moreover, it can develop within a few minutes in the form of an allergic shock, or appear after a few days. The most common allergens are sulfonamides, antibiotics, enzymes, anesthetics, vaccines, serums, barbiturates, preparations of heavy metal salts, iodine and bromine.

Symptoms of medicinal stomatitis

Complaints and symptoms depend on the clinical and morphological form - in dentistry, catarrhal, erosive and ulcerative-necrotizing medicinal stomatitis are distinguished. During the catarrhal process, the patient is bothered by itching and burning of the mucous membrane in the affected area, and a feeling of discomfort when eating spicy, salty and sour foods. The mucous membrane is edematous, there is pronounced hyperemia, there are no rashes. When examining the tongue, the dentist may detect papillary atrophy and hyperemia.

The erosive form is characterized by pain when talking and eating, deterioration in health, weakness and low-grade fever. Blisters appear in the mouth, after opening which an erosive surface remains. The most severe form of ulcerative necrotic stomatitis is medicinal stomatitis. The patient complains about severe pain, especially when in contact with food or drinks, bad breath, weakness, general malaise and fever. Pathomorphological elements on the edematous hyperemic mucous membrane are represented by erosions, ulcers and areas of necrotic tissue. Regional The lymph nodes enlarged and painful on palpation. This variety diseases should cause particular concern due to high risk addition of a secondary infection. In any form of drug-induced stomatitis, the patient may be bothered by dry mouth and impaired salivation.

A separate category is fixed medicinal stomatitis, in which single or multiple spots up to 1.5 cm in diameter appear on the oral mucosa. In the middle of a spot or group of spots, a small vesicle with serous contents forms, opening almost immediately after its appearance. The next time you come into contact with the allergen drug, the bubble appears in the same place. This disease is characterized by a complaint of pain when opening the mouth. The development of this form is also caused by sulfonamides, tetracycline and barbiturates, but in dental practice it is distinguished as separate species.

Diagnosis of medicinal stomatitis

For a competent diagnosis, it is necessary to thoroughly study the patient’s allergy history, i.e. find out whether the development of the disease is associated with taking any medications, whether such episodes have been noted previously, whether there are any other manifestations of allergies, etc. After this, the doctor proceeds to a full examination, including an assessment of the condition of the skin and mucous membranes. From auxiliary methods skin allergy tests are used, biochemical analysis blood, determination of specific IgE to drug allergens.

Differential diagnosis of medicinal stomatitis is carried out with exudative erythema, herpes and Vincent's ulcerative necrotizing stomatitis. All these diseases have no relationship with taking any medication, and improvement has nothing to do with its discontinuation. In addition, when herpetic stomatitis The rash covers not only the oral cavity, but also the red border of the lips, as well as the skin on the face. Acute catarrhal gingivitis is noted. With Vincent's ulcerative-necrotizing gingivitis, deep ulcers form on the mucous membrane, the surface of which is covered with a gray coating, gingival papillae take the shape of cones and bleed. The patient is worried putrid smell from mouth.

Treatment of medicinal stomatitis

The treatment regimen is formed based on the form of drug stomatitis, but in all cases the main thing is to eliminate contact with the allergen drug and follow a gentle diet with the exception of irritating foods. For all forms, oral administration is prescribed to reduce sensitization. antihistamines(cetirizine, loratadine, desloratadine). The ulcerative-necrotic form may require oral administration glucocorticoids (prednisolone).

Used to reduce pain and discomfort local anesthetics(ointment with anesthetic, lidocaine in spray form). In the case of erosive and ulcerative-necrotic forms, regeneration stimulants, for example, adhesive dental paste, are used to accelerate healing. For the treatment of ulcerative necrotic drug-induced stomatitis, proteolytic enzymes (trypsin, chymotrypsin) are additionally prescribed to remove necrotic masses. It is important to remember that in some patients the allergic reaction can be very severe, even developing life-threatening conditions - Quincke's edema and anaphylactic shock. In this case, urgent hospitalization is indicated.

Elimination of contact with the allergen and proper drug treatment quickly leads to an improvement in the patient's condition. In the absence of therapy, especially in the case of ulcerative-necrotic form, there is a high risk of secondary infection and various purulent complications. It is also very important to conduct a full allergy examination and determine which drugs you are sensitized to in order to avoid contact with them in the future.

Drug stomatitis is a symptom of drug allergy (drug disease). They are a consequence of various medications that can act under certain conditions as allergens and cause an immune response, accompanied by damage to the oral mucosa, alone or in combination with other mucous membranes, skin and organs. A prerequisite for the development of drug allergies is repeated use of the drug. After the first contact with the drug, a latent period begins (10-20 days), during which the drug-protein complex induces the formation of antibodies capable of realizing an allergic reaction in a period from several minutes (allergic shock) to several days (urticaria, allergic stomatitis) in response for the next administration of the drug. Stomatitis occurs more often when taking drugs orally. Allergens can be all medicinal substances, most often antibiotics, sulfonamides, anesthetics, vitamins, enzymes. Clinic. Symptoms of medicinal stomatitis, nature clinical changes are largely determined by: a) the type of immunological response; b) localization of the pathological process. Classification According to the nature of morphological changes in the mucous membrane: a) serous; b) exudative-hyperemic; c) erosive and ulcerative drug-induced stomatitis. According to the localization of the pathological process: stomatitis, palatinitis, glossitis, cheilitis, angular cheilitis. The occurrence of drug-induced stomatitis may be preceded by minor malaise, itching of the skin of the palms, urticaria, swelling of the soft tissues of the face and lips. From the oral cavity - disturbances in salivary secretion, limited or diffuse swelling of the mucous membrane with severe tissue hyperemia. The development of exudative eruptive elements (from papular to vesicular-bullous) located endoepithelial is possible. The latter contain serous fluid, are tense, and quickly open, forming erosions of various shapes and lengths. In some cases, in response to a drug allergen, a syndrome is formed - exudative erythema multiforme. Diagnosis of drug-induced stomatitis is based on medical history, clinical symptoms and the results of cytological and immunological studies (eosinophils predominate in the smear), as well as data from an allergological examination. Treatment. Avoid contact with the allergen. Antihistamine therapy. Locally: rinse the mouth with 0.5-1% sodium bicarbonate solution or green tea infusion. Examples of intoxication are arsenous keratosis, melanosis, mercury, bismuth, hydantoin gingivitis. The diagnosis of drug intoxication can be confirmed to some extent by laboratory detection of increased amounts of the drug in the blood or excrement (for example, mercury levels greater than 0.02 mg/l or the presence of sulfonamide crystals in the urine). Laboratory diagnosis of poisoning is usually possible during the period of acute clinical manifestations of intoxication associated with the circulation of the drug in the blood. Exudative erythema multiforme (EME) is an acutely developing disease characterized by polymorphism of eruptive elements on the skin and mucous membranes, a cyclical course and a tendency to relapse in the spring-autumn period. According to pathogenesis, there are two forms of this disease - infectious-allergic and toxic-allergic MEE. In the infectious-allergic form of the disease, through allergological examination methods, sensitization of the body with bacterial antigens - staphylococcus, streptococcus, Proteus, E. coli - is revealed. The second form of MEE develops in individuals with hypersensitivity to various chemicals (washing powders), including medications. This form is not characterized by seasonality of relapses. Simultaneously with the skin, the mucous membrane, including the oral cavity, is affected. The duration of the disease is 2-3 weeks. Clinic. Acute onset, body temperature rises. Accompanied by general malaise, headache, muscle and joint soreness. Characterized by burning of the mucous membrane and hypersalivation. By the end of the second day, eruptive polymorphic elements appear on the mucous membrane - edematous and brightly hyperemic. Localization of pathological elements: red border and mucous membrane of the lips, cheeks, lateral surface of the tongue, rarely the palate. On the second and third days of the rash period, confluent blisters of subepithelial localization form. On the mucous membrane there are ulcers covered either with a bladder cap or thick fibrinous, gray, film. When the lid of the bladder is pulled, it is torn off along the border with unchanged tissues, which is accompanied by significant bleeding and pain. There is a cyclical pattern in the development of the clinic, manifested by the appearance of fresh rashes, which are preceded by chills and increased body temperature. According to the course of the disease, there are: mild, moderate and severe clinical forms of MME. Stevens-Johnson syndrome is a clinical form of a severe course of the disease, most often of toxic-allergic origin. Leaks from severe symptoms general intoxication. Along with damage to the oral mucosa, rashes are noted on the skin of the arms, legs, as well as the genitals, and the conjunctiva of the eyes. Differentiate this clinical form The disease follows with herpetic stomatitis, acantholytic pemphigus, drug stomatitis, Lyell's syndrome. Treatment. Local and general treatment patients, MEE can be carried out using the ODE scheme for patients with CRAS. However, when treating Stevens-Johnson syndrome, hospitalization with the use of corticosteroid drugs and immunocorrective therapy is preferable. When preparing this question, carefully study the LDS and the MEE differential diagnosis table.

Drug-induced stomatitis is a pathology of the oral mucosa of allergic origin that develops after contact with various medications.

Clinic

According to clinical and morphological characteristics, this type of stomatitis is divided into:

Catarrhal

Erosive

Ulcerative-necrotic forms

The catarrhal process is characterized by patient complaints of itching and burning of the mucous membrane in places where the lesion subsequently develops. The patient is also concerned about discomfort when eating sour and salty foods. The surface of the affected mucosa is swollen, bright red, without rash elements. When the tongue is affected, atrophy of its papillae is noted, and the linguistic surface is red.

For erosive form Typical complaints are pain during conversation and eating. Of the elements of the lesion, the most common are vesicles and blisters, which, when opened, form an erosive surface. Also, with this form, health deteriorates - weakness, weakness, body temperature increased to 38C.

The ulcerative-necrotic process is characterized by local and general manifestations. Erosion, ulcers, and areas of necrosis located on the inflamed mucous membrane are found in the oral cavity. There is an increase and pain in the regional lymph nodes. The general condition also suffers; the disease is characterized by: loss of appetite, weakness, fever.

It is necessary to differentiate drug-induced allergic stomatitis from the following diseases:

Exudative erythema

Herpetic lesion

Venasan ulcerative-necrotic gingivitis, which is characterized by bleeding and changes in the shape of the gingival papillae (they take the shape of a truncated cone), there are ulcers on the mucous membrane covered with a dark gray coating. Noted bad smell from mouth.

A history of use of any medications allows an accurate diagnosis to be made.

Treatment of medicinal stomatitis

The treatment plan for each form of drug-induced damage to the oral mucosa is different.

The catarrhal form requires discontinuation of the drug that caused the development of the pathology. In this case, it is necessary to replace it with another one. General treatment consists of taking antihistamines (tavegil or suprastin) and vitamin therapy. If the lesions cause pain, they can be treated locally with anesthetic ointments.

If an erosive form of the disease develops, it is necessary to eliminate the effect of the allergen. After this, antihistamines are prescribed. Within local treatment glucocorticosteroid and anesthetic ointments are used. During the healing period, agents that accelerate healing are effective.

For ulcerative-necrotizing allergic stomatitis, they are prescribed orally antihistamines and corticosteroids. Local treatment is the use of anesthetic ointments, proteolytic enzymes (to remove necrotic masses) and healing drugs.

For any form of drug-induced allergic stomatitis, it is necessary to strictly follow a diet, excluding irritating foods.

Drug-induced stomatitis, treatment

When medicinal substances are taken orally or administered parenterally, an allergic reaction of the body may develop, accompanied by the appearance of rashes on the oral mucosa. However, there is no specific clinical course for each drug. The same substances cause catarrhal inflammation on the oral mucosa in some people, blisters in others, spots or swelling in others, etc. Various combinations of rashes are possible. Among the medicinal substances that cause side effects in the form of medicinal stomatitis, the following should be highlighted: 1) sulfonamide drugs; 2) antibiotic preparations: 3) bromine, iodine preparations; 4) preparations of heavy metal salts (mercury, lead, bismuth). Of these drugs, the first two are the most common cause drug-induced stomatitis, however, individual sensitivity to other medicinal substances is possible. When using a drug for the first time, a reaction may occur immediately or after several hours, which indicates special sensitivity (idiosyncrasy) to this drug. Sensitization (increased sensitivity) occurs, which can lead to a change in the reactivity of the body. Repeated use of this drug most often entails the development of an allergic reaction. 1. The reaction from the use of sulfonamide drugs (streptocide, sulfidine, sulfazole, norsulfazole, etazol, etc.) occurs on the 3rd day if the drug is used for the first time, and after repeated use - after a few hours. In this case, diffuse redness appears, against which single or multiple bluish-red spots appear, as well as blisters, after opening of which long-term non-healing erosions remain. Rashes also appear on the lips (cheilitis), where the drying exudate forms bloody crusts, making it difficult to open the mouth. A general reaction of the body is possible in the form of an increase in body temperature and the development of eosinophilia. Cases of hemolytic anemia and agranulocytosis have been described. 2. The use of antibiotics may be accompanied by a general and local reaction, which occurs immediately after administration of the drug or after some time with prolonged use. On the part of the oral cavity, in the area of the soft and hard palate, cheeks, lips, and tongue, diffuse redness and swelling appear. The gingival papillae are sharply hyperemic, swollen, rounded, lag behind the necks of the teeth, a light touch is accompanied by bleeding. The condition of the tongue is especially characteristic in this case: against the background of diffuse redness, the papillae of the tongue become smoothed out and then completely disappear, causing the tongue to acquire a smooth, shiny, as if varnished, surface. Pain and burning appears. The oral mucosa is dry, sensitive to external irritants, and easily vulnerable. On the background catarrhal stomatitis Spots and bubbles may appear. In this case, the clinical picture is very similar to multiform exudative erythema. Information about the ingestion of medications helps in making a diagnosis. In severe cases, with repeated use of penicillin, pain in the joints and muscles appears, swelling of the joints, itching of the skin, body temperature rises, lymphadenitis is observed, eosinophilia up to 60% in the blood, traces of protein in the urine. The most severe complication is the development of anaphylactic shock. Long-term use of antibiotics suppresses the normal flora of the oral cavity, which promotes the growth of the fungus, its transition to a pathogenic state and the development of candidiasis. In this case, along with damage to the oral cavity, damage to other mucous membranes (gastrointestinal tract, vagina, respiratory tract etc.) and skin. Treatment is to immediately stop taking the drug that caused stomatitis, and the prescription of desensitizing and symptomatic drugs: 1) diphenhydramine - 0.05-0.1 g 3 times a day; 2) pipolfen - 1 tablet 4-5 times a day; 3) 10%) calcium chloride - 1 tablespoon 3 times a day; 4) 0.1% solution of adrenaline subcutaneously, 0.025-0.5 g. A complex of vitamins is prescribed orally. Local antiseptic treatment is carried out with a 1-2% chloramine solution in the form of baths, and oral cavity sanitation. Usually, after stopping the medication, the symptoms of stomatitis soon disappear. 3. Bromine and iodine preparations cause widespread redness and swelling of the entire oral mucosa, sharp pains in the gums, increased salivation. At the same time, iodine runny nose, conjunctivitis and diarrhea develop. Acne, blisters and granulomas (iododerma, bromoderma) appear on the skin. 4. Salts of heavy metals (mercury, bismuth, lead) can also cause the development of stomatitis in case of increased sensitivity to them or as an occupational disease.

Inflammation of the oral mucosa caused by taking any medications is drug-induced stomatitis. Specific manifestations in the form of blisters, ulcers or spots can occur both due to the use of drugs orally (orally, intravenously, intramuscularly) and due to contact of the mucous membrane with certain substances.

Drug-induced stomatitis - prices

Consultation

from 1,500 to 4,000 rubles.

Causes of medicinal stomatitis

Drug stomatitis manifests itself in the form of rashes. Their location depends on the type of reaction. With contact stomatitis, the area to which the drug was applied becomes inflamed; in general, the entire mucous membrane is affected. Also in some cases the following symptoms are observed:

deterioration general condition;
weakness, dizziness, headache;
slight increase in body temperature (low-grade fever).

Treatment of medicinal stomatitis is prescribed after the cause and degree of neglect of the problem have been established.

It is almost impossible to determine exactly why drug-induced stomatitis appears, since the mechanism of development is not fully understood. However, experts consider it a reaction immune system to unidentified substances with which she begins to fight. That is, the body, in response to an irritant, actively produces lymphocytes, which leads to specific manifestations.

Most often, drug-induced stomatitis in acute form diagnosed in children and young people. Also at risk are patients suffering from infectious diseases or allergic reactions. Factors such as insufficient hygiene, dysbacteriosis, caries, gastrointestinal disorders, herpes virus, etc.

According to clinical and morphological symptoms, drug-induced stomatitis is divided into three main types:

1. Catarrhal. The affected areas of the mucous membrane are bright red, swollen, but without rashes. Patients complain of burning and itching in inflamed areas.
2. Erosive. Characterized by painful sensations while eating or talking. Rashes on the mucous membrane appear in the form of bubbles that burst and form erosions. Drug-induced stomatitis of this type can give a temperature of up to 38 degrees, as well as a deterioration in the general condition of a person.
3. Ulcerative-necrotic. Main manifestations: erosions, ulcers and areas of necrosis in the affected area. Characteristic symptoms of this species include loss of appetite, general weakness, increased temperature, enlarged regional lymph nodes.

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Treatment of medicinal stomatitis

Treatment of drug-induced stomatitis follows a scheme that is determined by the form of the disease. However, in any case, the patient must first stop taking medicinal product, which became the cause of the pathological process.

For catarrhal form. Treatment of drug-induced stomatitis involves taking antihistamines and vitamins. The affected areas are treated with anesthetic ointments.

For erosive form. The regimen includes taking antihistamines, treating the mucous membrane with glucocorticosteroid and anesthetic ointments.

For ulcerative-necrotic form. Antihistamines and corticosteroids are prescribed. For local treatment, drugs with proteolytic enzymes, painkillers and healing ointments are used.

Local symptoms of any form can be effectively relieved by regular applications and rinses. Drug-induced stomatitis goes away quite quickly if the patient strictly adheres to the doctor’s recommendations and also follows a diet.