Polymorphous exudative erythema. Erythema multiforme exudative. Causes. Symptoms Diagnostics. Treatment

Exudative erythema multiforme - acute illness skin and mucous membranes, characterized by polymorphic rashes. The disease has a tendency to relapse, appearing in the spring or autumn.

Exudative erythema multiforme occurs mainly in young people, and middle-aged people are also common patients.

The disease may be associated with some provoking reasons:

• sensitization of the body to certain types medicines;
• availability infectious diseases, against the background of which erythema develops.

In the first case, a symptomatic, or toxic-allergic form of the disease is implied, in the second - an idiopathic, or infectious-allergic form. The latter occurs in 80% of cases of the disease, the toxic-allergic variant - in 20%.

Causes of erythema multiforme exudative

Modern dermatology is not ready to clearly identify the objective causes and mechanisms of development of exudative erythema multiforme. It is known that approximately 70 percent of people have a certain focus of chronic infection: sinusitis, otitis media, chronic tonsillitis, pulpitis, pyelonephritis, periodontal disease and many other diseases, as well as increased sensitivity to antigens. In these patients, during an exacerbation of exudative erythema multiforme, a decrease in immunity is recorded. As a result, there was an assumption that the onset and exacerbation of the disease are caused by immunodeficiency, which develops rapidly against the background of focal infections in interaction with some complicating and provoking factors, namely:

• hypothermia;
• sore throat;
• ARVI.

Erythema multiforme is often associated with herpetic infections.

The main and most common cause of the toxic-allergic form of the disease is intolerance to certain medications:

• sulfonamides;
• barbiturates;
• tetracycline;
• amidopyrine and others.

In addition, the disease may appear after administration of serum or vaccine. From the point of view of allergology, exudative erythema multiforme is a mixed type hyperreaction, combining signs of immediate and delayed hypersensitivity.

Symptoms of exudative erythema multiforme

The infectious-allergic variant of exudative erythema multiforme has an acute onset of the disease, characterized by the following symptoms:

• general malaise;
• elevated temperature;
• headache;
• muscle pain;
• sore throat;
• arthralgia;
• rashes after 1-2 days against the background of general changes.

In approximately five percent of cases, the disease is localized only on the mucous membrane oral cavity, and one third of patients have damage to the skin and oral mucosa. There are rare cases when multiform exudative eczema affects the mucous membranes of the genitals. After the rash appears general symptoms illnesses gradually disappear, but can persist for up to three weeks.

Skin rashes with this disease are usually located:

• in the back of the hands and feet;
• on the soles and palms;
• on the extensor areas of the elbows and forearms;
• in the areas of the legs and knees;
• in the genital area.

The rashes are red-pink, swollen, flat papules with clear boundaries. They grow rapidly, reaching from two millimeters to three centimeters in diameter. The central part of the papules sinks, and its color becomes blue. Blisters with bloody or serous contents may also appear here. In addition, the same bubbles appear on apparently healthy areas of the skin. The polymorphism of rashes is due to the fact that blisters, pustules and spots are present on the skin at the same time. In most cases, the rash is accompanied by a burning sensation and sometimes itching.

In case of damage to the oral mucosa, elements of exudative erythema multiforme are localized on the cheeks, lips and palate. At first, the rashes appear as areas of limited or diffuse redness of the mucous membrane, and after 1-2 days, blisters appear in areas of exudative erythema multiforme, which open after the next two to three days and form erosion. Merging, erosions capture the entire surface of the oral mucosa, covering it gray-yellow coating. When you try to remove the plaque, bleeding occurs.

There are cases when exudative erythema multiforme affects the oral mucosa with several elements without any pronounced pain. But practice shows that sometimes extensive erosion of the oral cavity occurs, preventing the patient from taking food, even in liquid form, and talking. In this case, bloody crusts appear on the lips, preventing the patient from opening and closing his mouth normally and painlessly. These rashes begin to disappear after two weeks, and finally disappear after about a month. The entire process on the oral mucosa can last for one and a half months.

Typically, the toxic-allergic form of exudative erythema multiforme does not have initial general signs and symptoms. There may be an increase in body temperature immediately before the rash. The toxic-allergic form, in terms of the characteristics of the elements of the rash, is practically no different from the other form of erythema - infectious-allergic. It is widespread and fixed; in both cases, infectious rashes affect only the oral mucosa. And with a fixed variant of the disease, during relapses of exudative erythema multiforme, rashes appear in the same places, as well as in new ones.

For of this disease characterized by a relapsing course followed by exacerbation in autumn and spring periods. In the toxic-allergic form of the disease, seasonality does not play a special role, and in some cases, exudative erythema multiforme is characterized by a continuous course due to constantly recurring relapses.

Diagnosis of exudative erythema multiforme

To diagnose the disease, a consultation with a dermatologist requires a thorough examination of the rash and dermatoscopy. When collecting anamnesis Special attention should be given possible connections with any infectious processes, as well as taking or administering medications. To confirm the diagnosis of exudative erythema multiforme, as well as to exclude any other disease, it is necessary to take fingerprint smears from the mucous membrane and from the affected areas of the skin.

Exudative erythema multiforme is differentiated from pemphigus, erythema nodosum, a disseminated form of systemic lupus erythematosus. Several of the following factors allow separating erythema multiforme from pemphigus:

• rapid dynamics and changes in the rash;
• negative reaction to Nikolsky's symptom;
• complete absence of acantholysis in fingerprint smears.

If the patient has a fixed form of exudative erythema multiforme, a differential diagnosis with syphilitic papules. Some signs identified during the study make it possible to exclude syphilis, these are:

• complete absence of pale treponema during dark field examination;
• negative RPR, RIF and PCR reactions.

Treatment of exudative erythema multiforme

Treatment even in acute period The disease completely depends on the clinical manifestations of exudative erythema multiforme. For example, if a patient experiences frequent relapses, mucosal lesions, disseminated rashes and the appearance of necrotic areas located in the center of the rash elements, then the patient is prescribed a single injection of 2 ml of diprospan.

If a patient has a toxic-allergic form, then the main task for using further effective treatment disease is the identification and removal from the affected body of the substance that provoked the occurrence of exudative erythema multiforme. For this purpose, the patient is prescribed to drink plenty of fluids, use diuretics and enterosorbents. In the situation of a first-time case of the disease or indications in the anamnesis of data on the independent rapid resolution of its relapses, the administration of diprospan, as a rule, is not required.

Regardless of the form of exudative erythema multiforme, the patient is prescribed desensitizing therapy and the following drugs:

• tavegil;
• suprastin;
• sodium thiosulfate;
• antibiotics.

The latter are used only for secondary infection of the rash.

Local treatment for exudative erythema multiforme is carried out through the use of applications consisting of antibiotics with proteolytic enzymes, as well as lubricating the affected skin with special antiseptics: a solution of furatsilin or chlorhexidine. As a treatment, it is allowed to use corticosteroid ointments, which include: antibacterial drugs- dermazoline or trioxazine. In case of damage to the mucous membrane, it is necessary to rinse with Rotokan and chamomile decoction, as well as lubricate sea ​​buckthorn oil.

Prevention of relapses of exudative erythema multiforme in the infectious-allergic form is closely related to the identification and elimination herpetic infection and chronic infectious foci. To do this, the patient will need to consult a qualified otolaryngologist, urologist, dentist and other specialists.

With the toxic-allergic version of exudative erythema multiforme, it is important to prevent taking the medication that provokes the disease.

Spicy inflammatory process, concerning dermatological integuments and mucous membranes. Characterized by the appearance of a significant number of free-flowing polymorphic components.

The disease varies reappearance, exacerbation occurs in spring and autumn. The disease occurs at any age, but is most often recorded in children.

Due to the seriousness of the patient’s condition and the severity of the main manifestations, 2 forms of exudative erythema are distinguished:

Light proceeding without manifested pathologies general condition sick. With this form there are no lesions of the mucous layers.

Heavy, which is characterized by dermatological rashes and damage to the mucous membrane, accompanied by joint disorders from simple malaise to an extremely difficult general condition.

The rash consists of pinkish spots and red papules. This redness rapidly grows to 2-3 cm.

Polymorphic and exudative erythema appears in young and middle-aged people, in to a greater extent representatives of the stronger sex, but they are also found in children and the elderly.

In typical cases, the appearance of a rash is preceded by low-grade fever, painful condition, headache, lasting from 3 to 7 days.

Malignant exudative erythema affects people from twenty to forty, while its frequency among representatives of the stronger sex is 2 times higher. But described individual cases among children.

Where does the disease come from?

It is assumed that exudative erythema in 70% of patients is provoked by decreased immunity against the background of prolonged bacterial infections. Inflammation maxillary sinus, an inflammatory process in the ear, an inflammatory process occurring in the palatine or pharyngeal tonsils, and a non-specific infectious kidney disease increase the body’s susceptibility to pathogens. The disease can also be localized in your oral cavity.

Another 30% of people develop a toxic-allergic form of the disease. The rash occurs after vaccination, the inclusion of serums, and taking medications derived from barbituric acid.

Read more about the causes of allergies

The infectious-allergic form is the most popular variation of the disease. It is characterized by the appearance of blue reddish spots with swelling (rounded), delimited from the healthy epidermis. Vesicles (bubbles) form in the spots.

Infectious-allergic variation mainly localized on upper limbs, and may appear together with a burning sensation and minor pain. Let's look at what the shape of erythema looks like in the photo.

The rashes persist for 7 to 14 days, and then disappear, leaving brown pigmentation. This form occurs in 80% of situations and is usually caused by a herpes infection. In some cases, the culprits are bacterial or viral infections, as well as a reaction to medications.

Read more about the causes of toxic-allergic erythema

The toxic-allergic form of multiforme and exudative erythema is not characterized by seasonal relapses; as a rule, its formation is preceded by general signs. In some cases, these symptoms occur, mainly in the form of a temperature reaction; rashes may occur with a common type of disease.

The traditional type of exudative erythema multiforme with damage to the mucous layers is characterized by changes in both the epithelial and connective tissue layers. In some cases, large changes can be seen in the epithelial cover in the form of necrosis, in others - changes in the connective tissue cover in the form of rapidly developing edema with the formation of blisters.

Other reasons

Scientists emphasize several causing conditions that have big influence on the formation of the disease exudative erythema:

• with inflammation of the nasal appendages;
• systemic damage to the periodontal tissue (periodontal);
• with sore throat;
• the presence of diseases caused by the herpes virus;
• intolerance to certain pharmaceutical substances;
• hypothermia of the body;
• decreased immunity.

The body's hypersensitivity to irritating conditions and stress is of great importance. The formation of the disease erythema multiforme can be caused by injuries to the integument, excess ultraviolet radiation, overheating.

Symptoms at the onset of the disease

Exudative erythema is more often recorded in a child aged 5-7 years and is considered the result of allergic interactions with provoking agents (medicines, household chemicals, food products food).

The appearance of polymorphic rashes is traditionally preceded by a sudden complication general health. Children experience fever, joint pain and headaches. The eruptive components shock the oral mucosa at the same time. All the variety of eruptive components can be analyzed in a photo of erythema in a child.

Clinical signs of the disease in children and adults are similar. The disease is especially difficult to resolve when the mucous membranes of the oral cavity are affected. The child refuses to eat. This further exhausts the already exhausted child and reduces the body’s defenses. Exudative erythema in young children has a recurrent appearance and can appear from time to time throughout life, but in some cases the disease suddenly disappears by the age of 17.

The disease is characterized by an acute onset and the appearance of flu-like symptoms:

• increased body temperature;
• sore throat and headache;
• joint pain;
• sore throat, coughing;
• general painful condition, impotence;
• loss of appetite;
• muscle pain, body aches;
• enlarged lymph nodes.

Further symptoms

The area of ​​erosions can grow, they are predisposed to merge with each other, as a result of which the sources are spread over a significant area of ​​​​the mucosal plane, causing severe pain, which is even more intensified when eating and talking. In a child, this leads to a refusal to eat and rapid dehydration of the body with the formation of a serious condition.

Then, in the scarlet border of the lips, erosions become covered with brownish fibrinous, sometimes brown, bloody crusts, and in the oral cavity - plaque. Exudative erythema multiforme in the oral cavity is accompanied, in addition to painfulness, by increased salivation and inflammation of the gums.

1–2 days after the onset of the disease, the skin is affected by lesions the size of grains. The infection progresses, the components of the rash reach 2–3 cm in diameter. The papules rise slightly above the surface of the integument and are scarlet in color. In the middle there is cyanosis.

More about the nature of the rash

Polymorphic erythema is characterized by the appearance of a polymorphic rash (papules, vesicles, bullae, hemorrhages). The rash consists of clearly visible pink or scarlet papules, accompanied by swelling. They are prone to rapid growth, their diameter reaching in some cases up to 3 cm.

As the disease develops, the center of the papules begins to sink, acquiring a blue color. In their area, blisters appear with exudate from blood or clear protein fluid secreted serous membranes. Similar formations begin to appear on the healthy plane of the epidermis. The rash is characterized by a burning sensation or intense itching.

After 1-2 days, and in some cases on 4 - 6 days from the onset of the first signs and within 1.5 - 2 weeks, rashes appear on the skin again, after which general position the patient improves slightly.

The rash has the type of small (1-2 millimeters) spots of a visually red color and a rounded shape, slightly rising above the skin level due to an edematous ridge. They rapidly increase in volume and reach a diameter of 20 millimeters.

At the same time, a nodular-papular rash of similar volumes and with precise contours also appears with the spots. The rashes do not tend to merge with each other and are characterized by a burning sensation.

After 1-2 days, spots and papules in the central part acquire a brown or dull violet-bluish tone. Between these 2 areas there is a dull, elevated corolla (a sign of a cockade). Later, a rash with watery contents forms in the center of the papule or spot, and then the walls dry out.

Localization of the rash

Characteristic for erythema multiforme Strict symmetry of the location of the rash is considered. The elements are localized to a greater extent on the plane of the forearms and the anterior plane of the legs, to a greater extent in the area of ​​the elbow and knee joints, on the anterior plane of the feet and hands, especially along the outer plane.

Less commonly, the rash occurs on the palms and soles, and in these cases the latter take on a diffuse blue-violet color. At the same time, new rashes appear on the shoulders and in some cases on the face (mainly in the area of ​​the reddish border of the lips), on the neck, on the skin of the sternum, in the perineum and foreskin. Individual episodes of single components on the scalp are also depicted.

Polymorphic erythema is characterized by the appearance of a symmetrical rash over the body and even the oral mucosa. Bullous erythema is localized on the extensor surfaces of the extremities.

In 5% of patients, the rash is localized only on the mucous layers of the oral cavity:

• on the lips and palate;
• inner plane of the cheeks;
• in the throat.

Treatment Basics

Dermatologist visually examines clinical picture, focuses on the presence of persistent infections and the use of pharmaceutical substances. An examination is carried out to determine the difference between the disease and urticaria, pemphigus. If there are lesions in the oral cavity, syphilis must be eliminated. The treatment plan is drawn up depending on the shape and severity of the disease.

For any form of the disease, erythema multiforme is prescribed hypoallergenic food, exception:

• citrus fruits;
• mushrooms;
• nuts;
• poultry meat;
• smoked products and any spicy food;
• cocoa;
• coffee and alcohol.

In case of damage to the oral cavity, liquid foods are used, drinking huge amounts of liquid. If swallowing is not possible, parenteral nutrition is administered.

With intense relapses, widespread lesions of the skin and mucous membranes, treatment of exudative erythema multiforme proceeds in inpatient conditions. Injections of glucocorticosteroids, in particular Diprospan, are presented. During primary infection hormone therapy not prescribed.

In the case of a toxic-allergic form, the toxic element must be detected and removed from the body. Sorbents, diuretics and plenty of fluids are used. Re-infection skin – indication for taking medications.

To eliminate itching, desensitizing substances (Suprastin) are obtained. When the disease goes away simultaneously with a viral infection, in this case the doctor prescribes taking drugs to enhance immunity, as well as drugs that eliminate the virus.

Multivitamins are needed to maintain immunity. The affected areas are wiped with antiseptics (Furacilin), lubricated with antibacterial ointments (Dermazolin), and therapy is not stopped until the rash completely disappears.

Exudative erythema multiforme (erythema exsudativum multiforme) is an acute polymorphic dermatosis of a predominantly infectious-allergic nature (idiopathic form of erythema), manifested by bluish-red rashes on the skin of the extremities, mucous membranes, and sometimes genitals, mainly in spring or autumn, prone to relapses. The toxic-allergic form (symptomatic) of exudative erythema is not characterized by seasonal relapses.

Information about etiology and pathogenesis . In the development of the idiopathic form of erythema, the main provoking factors are herpes, mycoplasma, staphylococcal, streptococcal and other infections. The presence of foci of focal infection in the maxillofacial area is detected in 2/3 of patients. These patients have increased sensitivity to various bacterial allergens, a decrease in humoral and T-cell immunity factors, neutrophil function, and an increase in B-lymphocytes in the peripheral blood. In the toxic-allergic form of erythema, hypersensitivity to various medications is detected (sulfonamides, contraceptives, antipyretics, pyrogenic drugs, penicillins, allopurinol, vaccinations against tularemia, cholera). Relapses of the disease are provoked by hypothermia, hyperinsolation and other meteorological factors. In some people, it is possible to detect the occurrence or exacerbation of erythema after consuming certain foods (nutritional factors).

Varieties : infectious-allergic (idiopathic), which affects most patients; toxic-allergic (medicinal).

Favorite localization . The extensor surfaces of the extremities, often the hands and feet, including the palms and soles, the area of ​​the elbow and knee joints, the face, the external genitalia, the oral mucosa, the red border of the lips, the nasal cavity, the conjunctiva, the anal canal. The rash can be limited, disseminated or generalized.

Nature of the rash . Initially, areas of limited erythema appear, against the background of which, after a few days, flattened miliary and lenticular papules of a bluish-red color with a recess in the center are formed (elements resemble a target or an iris). Bubbles and blisters, erosions, and bloody crusts form on their surface. When the mucous membranes are damaged, erosions with fibrinous plaque occur. The process may involve the trachea, bronchi, eyes, meninges, and kidneys.

Subjective sensations . Itching, less often burning and soreness in areas of skin rashes. Lesions of the oral mucosa are always accompanied by severe pain.

General phenomena . Fever, joint and muscle pain, weakness, malaise.

Data confirming the diagnosis . Acute onset, signs of intoxication, polymorphism and symmetry of bluish-red (dark pink) rashes. The duration of relapse is usually 3-4 weeks. Seasonality of relapses is observed in the infectious-allergic form of the disease. At mild flow dermatosis with the presence of vesicles and blisters, Nikolsky's symptom is negative.

Clinical forms

According to the severity of manifestations, they are distinguished:

Simple or light form(papular, usually occurs without affecting the mucous membranes).

Vesiculobullous form (moderately severe).

Bullous (severe form), including Stevens-Johnson syndrome.

Extremely severe form diseases (Lyell's syndrome). IN initial stage In the development of Lyell's syndrome, typical target-shaped skin rashes characteristic of erythema multiforme are detected in half of the patients. Then widespread erythema and epidermal necrolysis quickly appear.

Clinical picture

Simple form . Numerous typical papules with a diameter of 1-2 cm, with a depression in the center, are identified on the skin, which regress within 1-2 weeks. A blistering reaction on the oral mucosa is possible with the formation of bloody, dirty crusts, the appearance of swelling, cracks on the lips, and pain.

Vesiculobullous form . A few erythematous plaques, with a bubble in the center and a ring of bubbles along the periphery. Often the mucous membranes of the mouth and lips are involved in the process.

Relapses of the above forms of erythema multiforme are associated with reactivation of the herpes virus, since taking acyclovir in a number of patients leads to relief of exacerbations of dermatosis.

Bullous form (Stevens-Johnson syndrome) is a severe type of exudative erythema multiforme or a toxic-allergic reaction to taking medications. Extensive blisters and bleeding erosions and massive hemorrhagic crusts appear on the oral mucosa. Symptoms of cheilitis and stomatitis make it difficult to eat due to severe pain. Possible development of catarrhal or purulent conjunctivitis, corneal ulcerations, uveitis, panophthalmitis, lesions of the genital mucosa involving Bladder and urinary disorders. Multiple maculopapular rashes, blisters with a positive Nikolsky sign, and less commonly pustules are found on the skin, and sometimes paronychia occurs. Characterized by prolonged fever, the development of pneumonia, nephritis, diarrhea, polyarthritis, and otitis is possible. Without treatment, mortality is 5-15%. These manifestations must be differentiated from Lyell's syndrome. It is believed that the presence of a blistering reaction on more than 30% of the skin surface corresponds to the clinical picture of Lyell's syndrome.

Extremely severe form (Lyell's syndrome). Most cases of Lyell's syndrome are associated with patients taking medications, to a lesser extent the use of certain chemical compounds, as well as viral and mycoplasma infections, and vaccinations. In some cases (5% of patients) the syndrome develops without previous prescription medications.

A toxic-allergic reaction begins with damage to the face and extremities in the form of erythema, maculopapular rash, or typical rashes of erythema multiforme. Within a few hours to a day, the eruptive elements merge and occupy the entire skin. Next, thin-walled, flaccid blisters form, which quickly merge and look like whitish areas resembling tissue paper. Nikolsky's symptom is sharply positive. When the affected areas are traumatized, the necrotic epidermis easily peels off, exposing the red, eroded, painful surface of the papillary dermis, which clinically corresponds to a second-degree burn. In most patients, the erosive process affects the mucous membranes of the cheeks, lips, conjunctiva, skin and mucous membrane of the genital organs, and the perianal area. Epithelization of erosions begins with the period of blistering and continues throughout the entire period of the disease, which lasts about 3-4 weeks. During the recovery stage, abundant large-plate peeling and desquamation of the non-rejected necrotic epidermis in large layers are observed. During the development of the main clinical manifestations of Lyell's syndrome, high fever and influenza-like syndrome are characteristic. Renal failure, ulcerative-necrotic changes in the trachea, bronchi, gastrointestinal tract, various pathologies from the organ of vision, up to blindness. Detection of neutropenia in a peripheral blood test is a poor prognostic symptom. Mortality in Lyell's syndrome reaches 30% and depends on the area of ​​affected skin and the age of the patients (elderly people die more often). Possible causes of death: sepsis, gastrointestinal bleeding, severe water-electrolyte imbalance.

In addition to the above severe forms of toxic-allergic reactions, dermatologists often observe skin reactions on taking medications with a milder clinical course: widespread and fixed forms of exudative erythema multiforme.

At fixed form The mucous membrane of the mouth, genitals, and perianal area is affected. Relapses usually occur at the sites of former rashes. There may be no inflammatory reaction in the area of ​​the blisters. Seasonality of relapses is not typical.

For common form characteristic general phenomena(usually a temperature reaction) and the appearance of lesions in other areas of the skin. In order to prevent relapse of the disease, it is necessary to identify the allergen and subsequently develop recommendations for eliminating the patient’s contact with this provoking factor.

Histopathology. Vacuolar degeneration in the lower layers of the epidermis, necrosis of epidermal cells, suprabasal and subepidermal blisters without acantholysis. Lymphohistiocytic infiltration around the vessels and in the basement membrane area, extravasation of red blood cells.

Differential diagnosis . Pemphigus vulgaris(absence of erythema, papules, positive Nikolsky sign, presence of acantholytic cells in impression smears from erosions).

Dühring's dermatosis (herpetiform arrangement of elements, sensitivity to iodine, effect of using DDS in patients).

Chronic migratory erythema of Afzelius-Lipschütz (skin manifestations Lyme borreliosis). At the site of the tick's attachment, a bluish-red spot appears with a hemorrhagic crust in the center, which grows into a ring with an area the size of a child's palm or larger (stage 1). After a few weeks, as a result of the dissemination of spirochetes, cardiac and neurological symptoms appear (stage 2). A year or more after the tick bite (stage 3), complications develop: skin damage in the form of chronic atrophic acrodermatitis, severe changes in the joints, heart, central nervous system, and peripheral nervous system.

When establishing a diagnosis, it is also necessary to exclude drug toxicoderma, infectious exanthemas (scarlet fever, measles, rubella), dermatomyositis, thermal burns, phototoxic reactions, scalded skin syndrome.

Exudative erythema multiforme is a disease of the epidermal layer or the surface of the mucous membranes in acute form. Key Feature The disease is a rash on the skin. This pathology appears equally often in both children and adults, depending on the reasons. Exacerbations occur in autumn and spring.

Why does the disease appear?

There are certain factors that predispose to the occurrence of erythema multiforme in children and adults. Among them is the body's adaptation to long-term use some medications, as well as endogenous factor- chronic infectious processes in organism.

The first case is characterized by such a form of exudative erythema multiforme as symptomatic (toxic-allergic). The second option is called the infectious-allergic form of erythema.

Important! Case histories of exudative erythema multiforme indicate that more than 70% of patients are diagnosed with an infectious-allergic type of the disease.

• inflammation maxillary sinuses- sinusitis;
• inflammation of the middle ear - otitis media;
• inflammation of the tonsils in the throat - tonsillitis;
• inflammation of tooth tissue - pulpitis;
• chronic inflammation of the urinary system - cystitis, pyelonephritis.

Important! The cause of the development of erythema multiforme may be a decrease in immunity against the background of hypothermia, tonsillitis, acute respiratory infections. viral infections, herpes.

The toxic-allergic form is caused by intolerance to certain medications, which include sulfonamides, tetracycline antibiotics, barbiturates, amidopyrine, salicylates, etc..

Sometimes exudative erythema develops due to the administration of serum or vaccine. In this case, the disease is a mixed type hyperreaction.

Important! One of the severe complications of exudative erythema multiforme is Stevens-Johnson syndrome (erythema malignant). During it, detachment of the epidermis occurs.

Clinical picture of the disease

The infectious-allergic form of the disease is characterized by an acute onset and the occurrence of the following symptoms:

1. General malaise.
2. Hyperthermia.
3. Headache.
4. Muscle and joint pain.
5. Painful sensations in the throat.
6. The rash appears a day or two after the onset of the disease.

More often, the rashes are located on the surface of the skin, sometimes on the mucous membrane of the mouth or genitals. After the rash appears, general clinical manifestations lasts up to two weeks, gradually decreasing intensity.

On skin the rash may be located:

• on the hands and feet;
• on the soles and surfaces of the palms;
• on inside elbows and knees;
• on the calves.

The rash appears as well-defined pink or red papules accompanied by swelling. They are prone to rapid growth, their diameter is sometimes up to three centimeters. As the disease progresses, the center of the papules begins to sink, acquiring Blue colour. In their place, blisters with exudate from the blood or serous fluid. Similar formations begin to appear on the healthy surface of the epidermis. The rash is accompanied by a burning sensation or intense itching.

Important! The multiformity of exudative erythema is associated with simultaneous appearance blisters, spots and papules on the skin.

If the oral mucosa is affected, the rashes are located on inner surface cheeks, lips and palate. At first, the affected areas look like blurred redness; after two days, papules appear on the affected areas, which open up after a few more days, leaving erosion in their place. These formations merge into one great erosion, which is covered with a grayish coating on top. If a person tries to remove this plaque, the sores begin to bleed.

Therapeutic measures

One of the areas of therapy is the use antihistamines

Treatment of exudative erythema multiforme is directly determined by the severity of symptoms and the form of the disease.

In severe infectious-allergic form with frequent relapses, the patient is prescribed a single injection of Diprospan.

Important! If a sick person suffers from a toxic-allergic form of the disease, key direction Therapy is the identification and removal from the body of the irritant substance that provoked an exacerbation of the disease.

Regardless of what form of the disease is diagnosed, desensitizing therapy is used using antihistamines (Tavegil, Suprastin, Claritin, etc.), sodium thiosulfate.

If the rash becomes infected, antibacterial medications are used.

TO local treatment includes the use of applications to the affected areas; For this purpose, antibiotics with proteolytic enzymes are used. The affected area of ​​the skin is also lubricated with antiseptic substances (Furacilin, Chlorhexidine, etc.).

Corticosteroid ointments are also used for therapy (as prescribed by a doctor).

If the oral mucosa is affected, rinsing with Rotokan is prescribed. Also, the affected areas in the mouth are treated with sea buckthorn oil or Chlorophyllipt.

Treatment with folk remedies for exudative erythema multiforme can act as adjuvant therapy after preliminary consultation with the doctor. Treatment only with folk remedies This is unacceptable, as this may aggravate the condition.

In order to prevent relapses of the toxic-allergic form of erythema, uncontrolled use should be avoided. medicines. Prevention of infectious-allergic erythema is timely treatment infectious diseases and taking immunomodulators.