Toxicoderma
Toxicoderma is an allergic lesion of certain areas of the skin of an acute inflammatory nature. Toxicoderma develops when an allergen is exposed to the body, which penetrates into the skin hematogenically.
The content of the article:
Causes of toxicoderma
Symptoms of toxicoderma
Diagnosis of toxicoderma
Treatment of toxicoderma
Toxicoderma
Toxicoderma against the background of other diseases is characterized by an extensive number of characteristic morphological elements of the rash and is accompanied by damage to all mucous membranes. In most cases, a disease such as toxicoderma proceeds by a standard mechanism, like a normal allergic reaction.
Unlike the usual course of allergic dermatitis, the causal factor of the toxicoderma disease does not need contact with the patient’s skin. Getting into the human body, the allergen is absorbed through the blood in various ways and then enters the skin through the blood vessels. With toxicoderma, the allergen’s effect on the skin occurs “from within” the body. The most severe forms of the disease include Stevens-Johnson syndrome and Lyell syndrome.
Causes of toxicoderma
Chemicals that are an allergen of the development of toxicoderma enter the body in a variety of ways: by inhalation, get inside with food, with injections of medications or after direct application to the skin.
Based on the causes of occurrence, dermatology identifies four common types of toxicoderma:
medications;
professional;
alimentary;
autotoxic.
Drug-induced type of toxicoderma
Drug-induced toxicoderma in the patient’s body develops after taking specific medications. It can be caused by drugs of the sulfonamide group, barbiturates, antibiotics, B vitamins and various serums.
Elementary type of toxicoderma
Elementary toxicoderma is associated with the use of a food product with various additives that are included in its composition — baking powder, dyes, preservatives. In terms of its spread, it ranks second immediately after the drug-induced form of toxicoderma.
Professional type of toxicoderma
Professional toxicoderma begins due to one-time contact or constant work with chemical compounds. One of the most active antigens are substances that contain a close benzene ring with chlorine or an amino group.
Autotoxic type of toxicoderma
Autotoxic toxicoderma occurs due to the influence of allergens and various toxins that are formed in the body during metabolic disorders. It can manifest itself in gastritis, stomach ulcer, pancreatitis, hepatitis and kidney diseases — pyelonephritis, hydronephrosis, chronic renal failure, in the case of malignant processes such as kidney adenocarcinoma, lung cancer, and intestinal cancer. Autotoxic toxicoderma tends to develop into a chronic form. Toxicoderma can also be caused by various metals used in dentures and various types of metal structures that are used in traumatology and orthopedics. The reaction occurs due to the content of chromium, cobalt, nickel, molybdenum in them, they enter the patient’s blood and sensitize the body.
Symptoms of toxicoderma
Toxicoderma, the treatment of which begins after the appearance of the first symptoms that appear two days after the penetration of an irritating factor into the body, is a fairly common disease.
The clinical picture of toxicoderma is characterized by a huge number of morphological symptoms that differ from each other. Skin rash can be in papular form, erythematous, vesicular, urticular and papullo-vesicular. Infection of the oral mucosa and lips has a vesicular erosive character. Sometimes toxicoderma can affect not only the oral mucosa, but also the genitals, the entire urethra, the anus and the walls of the rectum. Skin rash with toxicoderma is accompanied by sensations such as tension, burning, soreness and itching of the skin in infected lesions.
Different patients may develop a different morphological variant of toxicoderma for the same provoking allergen. A number of substances also contribute to the development of toxicoderma with a characteristic clinic for a particular case. For example, after taking iodine salts, the disease of toxicoderma can manifest itself in the form of so-called “iodine acne”. Acne is a soft juicy plaques that rise above the skin and are covered with crusts, under which there is a purulent content.
Toxicoderma is accompanied by malaise, a sharp rise in body temperature, as well as periodic arthralgias. Constant discomfort and severe itching in the places of rashes can be the main cause of disorders of the nervous system with increased irritability of the patient, emotional lability and sleep disturbance.
Depending on the spread of manifestations of the disease, dermatologists distinguish two forms: a common and a fixed form of toxicoderma.
Fixed form of toxicoderma
The fixed form of toxicoderma manifests itself in most cases in the form of several erythematous spots on the skin with a diameter of 2-3 cm. In the future, rounded spots acquire a brown color, bubbles form in their middle. With the immediate elimination of the allergen from the body, this form of toxicoderma passes after about 10 days. With repeated exposure to the allergen on the body, a rash appears both in new areas that were not previously infected, and in the same places.
Common toxicoderma
Widespread toxicoderma is characterized by a multiple rash, often also accompanied by the development of myocarditis, hepatitis and renal failure. In the course of the development of the disease, the patient has fever, chills, vomiting and diarrhea, in general, the patient’s serious condition.
In accordance with the morphological form of the rash, toxicoderma is divided into spotted, papular, nodular and vesicular.
Spotted toxicoderma
Spotted toxicoderma proceeds favorably in most cases and is manifested by erythematous spots. Erythematous spots can be dotted, ring-shaped and roseolous. Spotty rashes are often edematous and peel off over their entire surface, mix with each other into extensive erythema. When peeling the center of the spot, it clinically resembles pink lichen. If the palms or soles are affected, the patient has a rejection of the stratum corneum.
Papular toxicoderma
Papular toxicoderma is characterized by the appearance of hemispherical island-inflammatory papules, which have a disseminated or limited character. The size of papules can be from miliary to lenticular. Sometimes, in the case of the use of anti-tuberculosis and diabetic drugs, the rash looks like lichen planus. In some cases, papules begin to merge into plaques. Patients are constantly worried about itchy skin.
Nodular toxicoderma
Nodular toxicoderma occurs due to the effect of sulfonamides, bromine, iodine preparations, vaccines, cyclophosphane, grissofulvin, methotrexate on the patient’s body. This form of toxicoderma manifests itself in the form of neoplasms of inflammatory and very painful nodes that are slightly located above the skin and have a vague shape.
Vesicular toxicoderma
Vesicular toxicoderma is characterized by the development of disseminated vesicles that are surrounded by an erythematous corolla. Vesicular toxicoderma is rarely limited to the defeat of the palms and soles alone. With a severe course of toxicoderma, vesicular erythroderma develops. In this form, secondary coccoid flora is added and pustules begin to form.
Diagnosis of toxicoderma
The basis for an accurate diagnosis of toxicoderma is a characteristic clinical picture. A dermatologist collects anamnesis, which is aimed at identifying the main cause of the disease. Toxicoderma is often confused with syphilis, pink lichen and psoriasis. In case of toxicoderma, the setting of standard allergic tests does not give results in most cases. The same applies to the use of provocative samples with an allergen, as a consequence of such studies, the danger of a severe form of toxicoderma may develop. To determine the provoking allergen, only in vitro tests are carried out: the reaction of basophil degranulation, leukocyte agglomeration and lymphocyte blast transformation.
In order to exclude the infectious nature of the rash, bacterial seeding of the discharge is performed, smear microscopy is performed on pale treponema, skin scraping for the presence of pathogenic fungi in it, as well as a test for syphilis. In the case of a neglected form of toxicoderma, the doctor conducts a coagulogram and makes a study of biochemical parameters in the patient’s blood and urine. If there is a suspicion of internal organ damage, a consultation with a cardiologist, gastroenterologist, nephrologist, as well as an ECG, ultrasound of the abdominal cavity, Echo-EG and CT of the kidneys will be required.
Treatment of toxicoderma
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