Erythema multiforme exudative

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Erythema multiforme exudative

Erythema multiforme exudative is an acutely developing disease characterized by the appearance of erythematous spots, bullous lesions of the skin, mucous membranes, and a cyclic relapsing course. Frequency – 0.3-0.5: 100,000 population / year, severe forms are noted 2-3 times more often in men.

Classification

    • The infectious-allergic (idiopathic) form is associated with hyperreactivity to allergens and infectious agents.
    • Toxic-allergic (symptomatic) form is associated with hypersusceptibility to drugs
    • Exudative malignant form (Stevens-Johnson syndrome)
    • Rheumatic erythema – rounded or arched foci of erythema on the trunk and extremities, sometimes observed in rheumatic fever.

Clinical picture

    • local symptoms
    • On the skin of the extensor surfaces of the forearms, legs, rear of the hands and feet, face, genitals, mucous membranes acutely appear symmetrical rashes. Appear edematous, clearly demarcated, flattened papules of pink-red color, rounded, with a diameter of several millimeters to 2-5 cm, having 2 zones: internal (grayish-cyanotic color, sometimes with a bladder in the center filled with serous or hemorrhagic contents) and external (red in color [cockade-like rash])
    • Diffuse erythema, blisters, erosive areas covered with a yellowish-gray coating appear on the lips, cheeks, and palate.
    • General symptoms
    • Burning and itching in the area of ​​rashes, soreness and hyperemia of the mucous membranes, especially the mouth and genitals
    • Fever
    • Headache and joint pain.
    • The most severe manifestation is Stevens-Johnson syndrome.
    • Large blisters on the skin and mucous membranes, after their opening, continuous bleeding painful foci are formed. Lips and gums red, swollen, with bloody crusts
    • If the eyes are affected, blepharoconjunctivitis, iridocyclitis, loss of vision are observed
    • Internal organs may be involved in the process
    • Not often rashes are found on the genitals.
    • In the toxic-allergic form, in contrast to the idiopathic form, there is no seasonal recurrence of rashes.

Research methods

    • Conduct laboratory tests to rule out syphilis – serological tests, tests for pale treponema
    • Symptoms of Nikolsky, Asbo-Hansen are negative, there are no acantholytic cells in smears-imprints
    • Histopathological examination reveals intra- and intercellular edema, hydropic degeneration of basal cells in the epidermis, edema of the papillary layer, perivascular infiltrates in the dermis. Differential Diagnosis
    • Chicken pox
    • bullous pem-phygoid
    • Duhring’s dermatitis herpetiformis
    • Shingles
    • Syphilitic papular eruptions.

Drug therapy

    • With a mild course – antihistamines and desensitizing agents.
    • With blisters and erosions on the skin – ointments with glucocorticoids and antibiotics (for example, gioksizon).
    • In case of damage to the oral mucosa – warm rinses with 10% sodium bicarbonate solution, local anesthetics (2% lidocaine), and glucocorticoids: dexamethasone elixir (0.5 mg per 5 ml of water) 4 r / day with subsequent winding.
    • In more severe cases and with common bullous forms – antibiotics (oral or parenteral), glucocorticoids (for example, prednisolone 1-2 mg / kg / day with a subsequent dose reduction), inhibitors of proteolytic enzymes (trasylol). With Stevens-Johnson syndrome, detoxification agents (hemodez, polyglucin) are indicated.

Forecast. The outcome of the disease in uncomplicated cases is favorable. With Stevens-Johnson syndrome, mortality is 10-30%.

Synonym. Erythema multiforme

See also Stevens-Johnson Syndrome (n1), /shs. 3-30

ICD. L51 Erythema multiforme