Erythema multiforme exudative

Erythema multiforme exudative
Erythema multiforme exudative is an acute disease of the skin and mucous membranes characterized by polymorphic rashes. The disease has a tendency to relapse, manifested in spring or autumn.

The content of the article:
Causes of multiform exudative erythema
Symptoms of erythema multiforme exudative
Diagnosis of erythema multiforme exudative
Treatment of erythema multiforme exudative
Erythema multiforme exudative
Erythema multiforme exudative occurs mainly in young people, and middle-aged people are also frequent patients.

The disease may be associated with some provoking causes:

sensitization of the body to certain types of drugs;
the presence of infectious diseases, against which the development of erythema is taking place.
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 multiform exudative erythema
Modern dermatology is not ready to clearly identify the objective causes and mechanisms of the development of multiform exudative erythema. It is known that about 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 hypersensitivity to antigens. In these patients, during the exacerbation of multiform exudative erythema, a decrease in immunity is recorded. As a result, it has been suggested that the occurrence and exacerbation of the disease are due to immunodeficiency, developing rapidly against the background of focal infections in interaction with some complicating and provoking factors, namely:

hypothermia;
angina;
ARVI.
Often, multiform exudative erythema is associated with herpetic infections.

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

sulfonamides;
barbiturates;
tetracycline;
amidopyrine and others.
In addition, the disease may manifest itself after the introduction of a serum or vaccine. From the point of view of allergology, erythema multiforme exudative is a hyperreaction of a mixed type, combining signs of hypersensitivity of immediate and delayed types.

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

general malaise;
increased temperature;
a headache;
muscle aches;
sore throat;
arthralgia;
rashes after 1-2 days against the background of general changes.
In about five percent of cases, the disease is localized only on the mucous membrane of the oral cavity, and one third of the patients have lesions of the skin and oral mucosa. There are rare cases when multiform exudative eczema affects the mucous membranes of the genitals. After the rash appears, the general symptoms of the disease gradually disappear, but may persist for up to three weeks.

Rashes on the skin with this disease, as a rule, are located:

in the rear of the hands and feet;
on the soles and palms;
on the extensor areas of the elbows and forearms;
in the areas of the shins and knees;
in the genital area.
The rashes are red-pink edematous flat papules with clear borders. 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 seemingly healthy areas of the skin. Polymorphism of rashes is associated with the fact that blisters, pustules and spots are present on the skin at the same time. In most cases, rashes are accompanied by burning, and sometimes itching.

In case of damage to the oral mucosa, elements of multiform exudative erythema are localized on the cheeks, lips and palate. At first, the rashes are areas of delimited or diffused redness of the mucosa, and after 1-2 days, bubbles appear on the areas of multiform exudative erythema, which open after the next two to three days and form erosion. Merging, erosions capture the entire surface of the oral mucosa, covering it with a gray-yellow coating. When trying to remove the plaque, bleeding opens.

There are cases when multiform exudative erythema affects the oral mucosa with several elements without any pronounced soreness. But practice shows that sometimes there is extensive erosion of the oral cavity, which does not give the patient the opportunity to eat even in liquid form and talk. In this case, bloody crusts appear on the lips of a person, 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 whole process on the oral mucosa can last for a month and a half.

Usually, the toxic-allergic form of multiform exudative erythema has no initial common signs and symptoms. There may be an increase in body temperature immediately before rashes. The toxic-allergic form, according to the characteristics of the elements of the rash, practically does not differ from another form of erythema — infectious-allergic. It is widespread and fixed in nature, in both cases, infectious rashes affect only the oral mucosa. And with a fixed variant of the disease during relapses of multiform exudative erythema, rashes appear in the same places, as well as in new ones.

This disease is characterized by a recurrent course with subsequent exacerbation in the autumn and spring periods. With the toxic-allergic form of the disease, seasonality does not play a special role, and in some cases, multiform exudative erythema is characterized by a continuous course due to constantly recurring relapses.

Diagnosis of erythema multiforme exudative
To diagnose the disease at a dermatologist’s consultation, it is necessary to carefully inspect the rashes and dermatoscopy. When collecting anamnesis, special attention should be paid to possible connections with any infectious processes, as well as to the intake or administration of medications. To confirm the diagnosis of multiform exudative erythema, as well as to exclude any other disease, it is necessary to take smears-prints from the mucosa and from the affected areas of the skin.

Multiform exudative erythema is differentiated with pemphigus, nodular erythema, a disseminated form of systemic lupus erythematosus. Several factors allow separating multiform exudative erythema from pemphigus:

rapid dynamics and change of rash;
negative reaction to Nikolsky’s symptom;
complete absence of acantholysis in smears-prints.
If the patient has a fixed form of multiform exudative erythema, differential diagnosis with syphilitic papules should be performed. Some of the signs identified during the study make it possible to exclude syphilis, these are:

complete absence of pale treponemes in the process of studying the dark field;
negative reactions of RPR, RIF and PCR.
Treatment of erythema multiforme exudative
Treatment, even in the acute period of the disease, completely depends on the clinical manifestations of multiform exudative erythema. For example, if a patient has frequent relapses, mucosal lesions, disseminated rashes and the manifestation of necrotic areas located in the center of the rash elements, then a single injection of 2 ml of diprospan is prescribed to the patient.

If the patient has a toxic-allergic form, then the main task for the application of further effective treatment of the disease is to determine and remove from the affected organism the substance that provoked the occurrence of multiform exudative erythema. For this purpose, the patient is prescribed copious drinking, the use of diuretics and enterosorbents. In the situation of a first-time case of the disease or indication in the anamnesis of data on the independent rapid resolution of its relapses, the introduction of diprospan, as a rule, is not required.

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

tavegil;
suprastin;
sodium thiosulfate;
antibiotics.
The latter are used only for secondary infection of rashes.

Local treatment for multiform exudative erythema is carried out by applying applications consisting of antibiotics with proteolytic enzymes, as well as lubricating the affected skin with special antiseptics: a solution of furacilin 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 use rinsing with “Rotokan” and chamomile decoction, as well as greasing with sea buckthorn oil.

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

With a toxic-allergic variant of multiform exudative erythema, it is important not to allow taking a medication that provokes the disease.

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