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

ICD-10

L51 Erythema multiforme

General information

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

Causes

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

Symptoms of erythema multiforme

Infectious-allergic erythema

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

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

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

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

Toxic-allergic erythema

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

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

Diagnostics

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

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

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

Treatment of exudative erythema multiforme

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

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

Prevention

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

Multiform (polymorphic, multiform) exudative erythema is a chronic disease accompanied by the appearance of a specific rash. The main difference from other forms of pathology is the formation of various elements on the skin and mucous membranes at the same time:

• dense knots;
• red spots;
• bluish blisters;
• blisters filled with cloudy watery contents;
• peeling;
• ulcers and crusts.

If large blisters form, they are removed and the wounds are treated with cooling solutions. Treatment continues until the rash resolves completely.

In children, the pathology is diagnosed in early age– 2–5 years. In most cases this is a consequence allergic reaction on household chemicals, cigarette smoke, food or medicine.

When studying the anamnesis, they check whether close relatives have allergies. More often, delayed reactions are observed (not immediately after contact with a harmful substance), which makes it difficult to determine the irritant. The disease can occur with seasonal relapses or year-round.

Before the rash appears, the temperature rises sharply to 37–38.5 ° C, headaches, joint and muscle pain are felt. Papules and blisters immediately appear on the limbs, forearms and in the mouth area. Spots on the body Pink colour enlarge and take on a bluish tint.

In case of severe damage to the mucous membrane, the child due to severe pain refuses food. Fasting leads to even greater exhaustion of the body. An aggravating factor is the presence of caries and decayed teeth in the mouth.

The disease can remain for life, periodically reminding itself of relapses. But sometimes it disappears spontaneously by the age of 14–16 years.

In 5% of patients, the rash is localized exclusively on the mucous membranes of the oral cavity:

• on the lips;
• in the sky;
• inner surface of the cheeks;
• in the throat.

At first there is slight redness, but after 1–2 days blisters form. After 2–3 days they burst, leaving painful erosions. The elements tend to merge and spread throughout the entire oral cavity. They are covered with a coating of gray or yellow color. If you try to remove it, the wounds begin to bleed and heal slowly.

Extensive erythema causes a lot of inconvenience, preventing a person from talking, even eating liquid food. Bloody crusts and cracks appear on the lips, preventing the mouth from opening. Infectious process makes dental hygiene difficult, salivation increases, and gingivitis (inflammation of the gums) develops.

However, the rash may consist of only a few small lesions. The resolution process on the mucous membranes takes longer than on the body - on average 1–2 months.

To prevent the body from becoming depleted from the inability to eat properly, first remove pain syndrome. Before eating, the rashes are treated with a 0.5% solution of novocaine, Lidochlor gel, or an anesthetic emulsion with peach oil.

To disinfect the mouth and relieve swelling, rinsing with chamomile decoction, treating rashes with sea buckthorn oil, weak solution hydrogen peroxide or Rotokan.

Prevention

To avoid frequent relapses of polymorphic exudative erythema, it is necessary to adhere to prevention. It is important to eliminate foci of chronic infections in a timely manner and prevent the development of caries.

In case of a toxic-allergic form, the body must not be exposed to medications that provoke the disease. It is recommended to balance the diet by removing foods that can cause allergies:

• citrus;
• nuts;
• chocolate and cocoa;
• alcohol;
• coffee;
• mushrooms.

You need to rely on sour milk, fruits, vegetables, cereals, lean meat and fish. In order not to injure the mucous membrane in case of lesions in the mouth, it is better to eat food in a ground form.

In addition, you should take vitamins in periodic courses, practice hardening procedures and exercise physical exercise to strengthen and maintain stable functioning of the immune system.

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All information is presented for educational purposes. Do not self-medicate, it is dangerous! Only a doctor can make an accurate diagnosis.

Exudative erythema multiforme is usually observed among people of average and young. This acute disease is accompanied by the appearance of various types of rashes on the skin and mucous membranes, which are prone to relapses and a cyclical course. As a rule, exacerbation occurs in the spring or autumn months.

Erythema multiforme exudative in most cases has a favorable prognosis. In this article we will introduce you to the causes, symptoms and treatment methods of this dermatological disease.

Causes

So far, scientists cannot name the exact causes of this disease. Exudative erythema multiforme can occur in two forms:

• toxic-allergic – observed in 20% of cases and caused by taking certain medications (sera and vaccines, barbiturates, tetracyclines, amidopyrine, sulfonamides);
• infectious-allergic (or idiopathic) - observed in 80% of cases and is often associated with the presence of a chronic focus of infection in the patient (rheumatism, etc.) and the appearance of a mixed type allergic reaction to an infectious pathogen.

During an exacerbation, infectious-allergic exudative erythema multiforme is accompanied by reversible, cyclic, spring-autumn, T-cell and neutrophil immunodeficiency. The presumptive cause of the development of this condition is the focus of infection. And factors such as hypothermia and taking medications can provoke a relapse.

Symptoms

Infectious-allergic form

With an infectious-allergic course, the disease begins acutely. The patient experiences general weakness, sore throat, fever, pain in the joints and muscles.

Skin rash

One or two days after the onset of the disease, the first elements of the rash appear. In 1/3 of cases they are localized on both the skin and mucous membranes. In 5% - only on the oral mucosa, and in extremely rare cases - they appear on the genital mucosa. After the onset of the rash, general symptoms gradually regress, but in some patients they persist for 14-21 days.

When localized on the skin, most of the elements of the rash are located on the extensor surfaces of the extremities, on the back of the feet, hands and in the genital area. Skin changes are swollen and flat papules of a red-pink color with clear contours. Initially, their size reaches 2-3 mm in diameter, but then it increases to 3 cm.

Over time, the center of the papules sinks and becomes bluish. In this place and on healthy areas of the skin, blisters filled with serous or bloody contents appear.

On the body of a patient with exudative erythema multiforme, different (i.e. polymorphic) elements of the rash may be present - papules, spots and blisters. Typically, they cause a burning sensation and are sometimes itchy. They usually regress within two weeks.

Rash on mucous membranes

In some cases, several elements of the rash appear on the oral mucosa, and they do not cause significant pain to the patient. In another case, the rash is so extensive that the patient cannot even take liquid or crushed food or talk. Delivery tissues form on the lips painful sensations bloody crusts that prevent you from opening your mouth. Such processes on the mucous membrane can take place over 1.5 months.

Toxic-allergic form

In the toxic-allergic course of the disease, the first general symptoms may be different. Sometimes there is an increase in body temperature before the appearance of the first rash, which is almost identical to the rash in the infectious-allergic form.

The rash can be fixed or widespread and almost always appears on the oral mucosa. During relapses, their elements appear in the same places as at the onset of the disease and spread to previously healthy areas skin. Exacerbations in the toxic-allergic form do not have such precise seasonality as in the infectious-allergic version.

Diagnostics

Diagnosis of exudative erythema multiforme consists of examining the patient and clarifying data on the presence of chronic foci of infection or the fact of taking medications. After this, to exclude other clinically similar diseases, the patient is prescribed an analysis of fingerprint smears from the surface of rashes on the skin and mucous membranes.

Differential diagnosis is carried out with the following diseases:

• disseminated form;

Treatment

Treatment tactics in the acute period depend on the manifestations of the disease. In case of frequent relapses, widespread rashes and the appearance of necrotic changes in the center of the rash elements, the patient is prescribed a single injection of a long-acting glucocorticoid such as Diprospan. If the disease arose for the first time and quickly ceased to recur, then the introduction of this hormonal drug is not required, and treatment may consist of prescribing antihistamines, vitamins and rash remedies.

For any form of the disease, the patient is prescribed desensitizing therapy:

• : tavegil, suprastin, etc.;
• aminocaproic acid;
• sodium thiosulfate;
• calcium gluconate, etc.

For secondary infection of rash elements, antibiotics are recommended.

For the toxic-allergic form of exudative erythema multiforme important role has the identification and rapid removal from the body of the substance that caused the disease. In addition to discontinuing the allergen drug, it is recommended to take enterosorbents and forced diuresis - taking diuretics and drinking plenty of fluids.

For local treatment of rashes the following are prescribed:

• applications of antibiotics with proteolytic enzymes;
• treatment of rash elements antiseptics(solutions of furatsilin or chlorhexidine);
• lubricating the rash elements with combined agents based on glucocorticoids and antibiotics (Dermazolin, Trioxazin, etc.);
• treatment of the rash after the onset of epithelization with keratoplastic agents (Solcoseryl, Karotolin, Vinilin, etc.);
• rinsing the mouth and irrigating the genitals with chamomile infusion, rotokan solution;
• lubricating mucous membranes with sea buckthorn oil.

To prevent recurrence of the disease in its infectious-allergic form, the patient is recommended to undergo an examination to identify a chronic source of infection (for its subsequent treatment) or therapy for a herpetic infection. The patient is prescribed consultations with an otolaryngologist, nephrologist (or urologist), dentist or other specialized specialists. With the development of exudative erythema multiforme in response to taking a drug, it is required complete failure from him reuse in future.

Is it possible to wash and is this disease contagious?

During the course of treatment of exudative erythema multiforme, the patient can take baths or showers. After finishing hygiene procedures It is recommended to treat the elements of the rash disinfectant solutions and application medicinal ointments, used at one or another stage of therapy for this disease.

Exudative erythema multiforme is caused by an allergic reaction and is not contagious to others. In mild cases, it can be treated at home and does not require any isolation of the patient or compliance with restrictions in everyday life.

Which doctor should I contact?

To treat exudative erythema multiforme, you must consult a dermatologist. To identify the cause of the disease and further prevent its exacerbation, the patient may be recommended to consult a dentist, otolaryngologist, nephrologist (or urologist) and other specialized specialists.

For people who suffer from allergies, there is no worse time than the off-season - spring and autumn. The time when wonderful aromas, pollen and other delights fly in the air becomes a real hell for an allergy sufferer. With all kinds of negative reactions on the environment, there is one unpleasant disease - erythema multiforme exudative. What kind of disease this is and how best to deal with it, you will learn from this article.

Getting to know the disease

Exudative erythema multiforme is complex disease, which is characterized by a variety of rashes throughout the body, including the mucous membranes. Also, such erythema can often recur more than once. Relapses occur during allergy seasons - spring and autumn. In children, exudative erythema multiforme appears as often as in adults and requires a special, gentler approach to treatment.

Forms of erythema.

There are two forms of erythema multiforme exudative:

1. Idiopathic erythema multiforme exudative. Idiopathic means one that appears without external reasons, by itself. Erythema of this type is characterized by the occurrence of symptoms due to infectious and allergic origin. The cause of an extensive rash can be the presence of an allergen in the body, but another irritant can also be a banal infection. A complex allergic reaction is the result of a weakened immune system and the entire body. Often carriers of idiopathic erythema have chronic, untreated infections. For example, caries, periodontal disease, tonsillitis, etc. Idiopathy can also be caused by different types of viruses.
2. If erythema is a common condition for the patient, then it often manifests itself in the off-season in 50% of patients. This form of erythema does not limit its victims in age, but mows down both large and small.

Symptomatic erythema multiforme exudative. The reason for the appearance of this form is only an allergen in the form unfavorable environment, medicines, air and other things. Among the most unsafe drugs, which tend to cause such allergies - all kinds of antibiotics, sulfonamides, barbiturates, serums for various purposes, vaccines and much more.

To summarize, the causes of exudative erythema multiforme are that the person is taking medication or other medical drug, or that a person has a certain infection, against which erythema may develop.

Symptoms of exudative erythema multiforme

Damage to the skin due to erythema.

This disease is characterized by an acute onset. That is, a healthy person can absolutely change for the worse in terms of health in a short period of time. The first symptoms are local pain throughout the body. Common places where pain may occur include the throat, muscles, and joints. Also, the initial stage is characterized by general weakness and unstable temperature. Outwardly, this may resemble overwork or common cold. Another mask behind which erythema can hide is sore throat.

If a person is overtaken by symptomatic erythema, then the exact reference will be the use of some drug that does not correspond individual characteristics the body of a particular person. If we compare the further course of these diseases, they are not at all different from each other.

Manifestation of erythema on the hands.

Skin irritation appears at the next stage. It is usually extensive, but symmetrical. Often the rash appears in sensitive places: in the bends of the elbows, near the hands, in the forearm area, sometimes near the face, on the neck, and feet. It is characteristic that almost always the ulcers “climb” onto the lip area. The problem is that such wounds make eating difficult.

Irritation on the skin first looks like small spots or spots with swelling, but then it intensifies inflammatory process. The spots have certain shapes and reach sizes of 5-15 mm in diameter. The color of such a rash is bright red, and something grayish appears around the edges. Sometimes the spots merge with each other, forming patterns and small ulcers on the body. But ulcers can also take the form of inflamed sacs - blisters, blisters. If you touch these blisters incorrectly, you can rip off a large area of ​​skin and even cause an infection. There are different types of ulcers among themselves.

• If a child suffers from such a disease, it is very important that he does not scratch his rash. Otherwise, the inflamed areas can become infected, which will only worsen the patient’s condition. To prevent the child from rubbing against the affected areas, topical creams should be used to reduce symptoms. But such creams must be agreed upon with the attending physician.
• Another way the disease manifests itself is a rash on the genitals, inflammation of the eyes (conjunctivitis). Special attention should be given to the skin that is located under the folds of the skin - a beneficial environment is created there for the proliferation of small bloody and purulent crusts. The rash is constantly renewed, and the previous symptoms remain in place. Fever, headache and weakness are constant companions of erythema.

The entire process of fighting the disease can take 10-15 days. During this time, the body must not only get rid of the irritant, but also restore itself to its previous form.

Diagnosis of the disease

For an experienced specialist (allergist or dermatologist), it will not be difficult to distinguish erythema multiforme exudative from everything else. In order to make a diagnosis, the doctor must collect anamnesis and ask the patient several essential questions:

1. What medications did the patient take before the onset of this body reaction?
2. What are you allergic to?
3. What unusual objects, things or environments did the patient come into contact with?
4. Any suspicions of allergens?

Based on all the symptoms listed above, the doctor must conclude that erythema is present, and then find out the reason for such a reaction of the body. To determine the pathogen, blood and urine tests, a detailed examination of patches on the skin, etc. are used.

Diagnosing erythema multiforme has some complications in that the disease can be a little reminiscent of some of the other favorite types of erythema, lupus.

The main differences between exudative erythema multiforme appear in two types. From erythema nodosum Exudative erythema multiforme is distinguished by the presence of spots in the first that resemble bruises, but such changes in skin color do not carry indurations or blisters. Erythema nodosum often occurs on the legs.

Chills are another form of an allergic reaction of the body to external destroyers. During chills, small nodules and patches appear on the limbs and constantly itch.

The etiology of erythema multiforme is not fully understood. In each specific case, you need to look for your own reason. To do this, a specialized doctor (allergist or dermatologist) must take certain tests. The most important test that can indicate that a person is struggling with erythema multiforme is a blood test. It shows how the body resists the disease, how many leukocytes are in the blood, etc. Urine is also taken for analysis.

Whatever the reasons for the occurrence of erythema multiforme, the main task of any attending physician is to remove the irritant allergen from the human body, which is causing the deterioration of health.

Treatment of the disease

Treatment of erythema multiforme is a long process that requires effort on the part of the patient. But after full course treatment increases the likelihood that the patient will not experience a relapse during the off-season.

The main focus of any doctor is the prevention of subsequent attacks. To do this, you need to find out which allergen is harmful, and also develop an action plan, a plan with which you can protect the patient as much as possible from contact with the irritant. The doctor must determine what type a particular exudative erythema multiforme is. After this, you can begin treatment directly.

If repetitions of such allergic reactions occur very often, and each period of the disease is accompanied by multiple rashes, damage to all mucous membranes, then an injection of diprospan should be used. This drug will not cause a second reaction in the body, but will cleanse it of all irritants.

It is better to avoid antibiotics, but in some cases of severe infection it is impossible to do without them. The doctor must carefully assess the risk that the patient may face: whether his weakened body can cope, whether there will be an allergic reaction, etc.

Disprospan is universal medicine for similar problems. Actually, with this medication there is no question of how to treat exudative erythema multiforme, since the drug has all the necessary properties for normal recovery the patient's body.

If the disease has affected or severely damaged the mucous membranes, then it is necessary to contact specialized specialists, for example, an ENT specialist or an ophthalmologist. These doctors must create their own additional system for treating damaged areas until complete recovery.

Additional help: traditional medicine

Arnica is a folk remedy to combat erythema.

Exudative erythema multiforme can also be treated with folk remedies. But it is important to use them only as an addition to the main one. drug method getting rid of the problem. Before you use traditional medicine, you should also consult your doctor.

It is one of the most useful plants in the fight against this disease - arnica. You can use it to make lotions for damaged areas, as well as useful vitamin decoctions for oral use. The recipe for the infusion is simple: pour boiling water over a collection of herbs, let it infuse, and then you can drink it 6 times a day, one spoon at a time. By using some additives you will get a good ointment. For the ointment, we use the herb, ground to a powder, mixed with pork fat. This mixture should be heated for three hours.

Prevention of erythema multiforme exudative

Prevention of erythema multiforme is simple.

• You must know exactly what substances, products, or environments you are allergic to. When you know your enemy by sight, it is much easier to avoid direct confrontation with him. Even during allergy season, you can come up with a way to avoid dealing with the cause of rashes and other unpleasant symptoms. Also, if you have any allergies, you should have a list of allergens and carry it with you in case of an emergency.
• Visit your doctor even if you have the slightest hint of this type of allergy or infection. Such diseases can be easily treated if you don’t neglect them and don’t give them a chance to dominate you.
• Do not leave any diseases untreated, especially infectious and inflammatory ones. Scientists have proven that exudative erythema multiforme occurs in 70% of cases in those who suffer from chronic diseases (caries, sinusitis, etc.).
• Have anti-allergy medications in stock. You should have them in your first aid kit.

This is very simple rules, which will make your life easier and protect you from possible relapses of an unpleasant disease.

Exudative erythema multiforme of the oral cavity

What is Exudative erythema multiforme of the oral cavity -

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

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

What provokes / Causes of Exudative erythema multiforme of the oral cavity:

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

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

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

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

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

The picture of peripheral blood during the period of exacerbation of exudative erythema multiforme corresponds to an acute inflammatory process.

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

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

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

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

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

Diagnosis of Exudative erythema multiforme of the oral cavity:

Exudative erythema multiforme is differentiated from:

acantholytic pemphigus;

nonacantholytic pemphigus;

acute herpetic stomatitis;

secondary syphilis.

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

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

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

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

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

Treatment of exudative erythema multiforme of the oral cavity:

In the acute period of the disease it is carried out symptomatic treatment, aimed at reducing intoxication of the body, desensitization, relieving inflammation and accelerating epithelization of the affected oral mucosa.

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

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

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

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

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

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

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

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

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

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

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

• Forecast

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

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

• Allergist
• Toxicologist

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