Erythema multiforme exudative. Differential diagnosis, treatment

Exudative erythema multiforme belongs to the category of allergic diseases, more common in young people. Not only the skin is affected, but also the mucous membranes.

In most cases, the activation of pathological processes occurs in autumn or spring. The disease is prone to periodic relapses. It is important to carry out differential diagnostics in order to establish the underlying cause of the pathology and choose the most effective method of treatment.

Definition of disease

Exudative erythema multiforme is an allergic disease in which specific rashes appear on the human body. They occur on the mucous membrane or skin. These can be spots, papules, or blisters.

Causes of occurrence

There are various provoking factors that trigger pathological processes:

• hypothermia of the body;
• immune deficiency states;
• ultraviolet irradiation;
• certain preservatives that are added to food;
• diseases of the digestive system;
• colds;
• bacterial infections;
• autoimmune disorders;
• malignant diseases;
• prolonged nervous tension, stress and depression.

In some situations, exudative erythema multiforme is inherited. The disease is also provoked by viral infections.

Histopathology

The histopathology of erythema multiforme in most cases depends on the clinical manifestations that accompany the rash on the body and mucous membranes.

The maculopapular form of the disease occurs with intracellular edema and lesions of the prickly layer of the epidermis. Bullous eruptions are characterized by the formation of bubbles under the epidermis. At the same time, degenerative-dystrophic processes in the area of ​​the thorny layer of the epidermis are absent.

Symptoms

Erythema multiforme begins acutely and is accompanied by pronounced symptoms:

• body temperature rises;
• general health worsens;
• a person is worried about pain in muscles and joints;
• there is weakness in the body;
• sore throat.

As the pathological processes progress, a person develops rashes on the body and mucous membranes:

Name	Description
Skin manifestations	Spots, papules, blisters appear in the form of primary morphological elements. They have a definite shape and clear boundaries, they react to touch and pressure. Secondary morphological elements are erosion, crusts and scales, which do not have individual clinical features.
Rash on mucous membranes	Pathological foci on the mucous membrane are formed in the form of bubbles. Over time, they burst and erosions form in their place, which are accompanied by severe painful sensations.

Any rash on the body is accompanied by severe itching. Papules and vesicles are filled with clear exudate. In most cases, pathological foci gradually merge with each other.

Classification and stages of development

Exudative erythema multiforme (differential diagnosis will allow a dermatologist to make an accurate diagnosis) develops against the background numerous factors, proceeds depending on the various characteristics of the current situation and the individual parameters of the organism person.

In medicine, the following main types of exudative erythema multiforme are distinguished:

Name	Description
Infectious-allergic	In 80% of cases, people are diagnosed with idiopathic or true exudative erythema multiforme. A chronic form of the disease, which is provoked by a focus inside the human body.
Toxic-allergic (symptomatic)	In most cases, the disease occurs with the use of certain drugs.
Steven Johnson Syndrome	Malignant form of exudative erythema, which is difficult and is accompanied by the appearance of blisters on the surface of the mucous membranes. The likely places of formation of pathological foci are the mouth, eyes, throat, genitals.
Rheumatic erythema	Pathological processes in most cases result from the development of arthritis. Specific spots appear on the body.

The disease is classified into types, taking into account the provoking factors:

Name	Description
Sudden	Pathological processes develop sharply and are accompanied by high fever. The patient develops flu-like symptoms.
Migratory	A common cause of the disease is an insect bite. A specific spot is formed at the site of exposure, which gradually grows.
Knotty	Not only spots are formed on the human body, but also subcutaneous foci, which outwardly resemble nodules.
Viral	The disease is more often diagnosed in children. The first signs are spots on the face, they gradually cover the entire body of the patient.
Persistent	A type of erythema that vasculitis provokes.

In medicine, there is also a certain classification of exudative erythema multiforme, given the severity of clinical symptoms:

Name	Description
Light form (small)	The general condition of the patient is satisfactory, the mucous membranes are clean.
Severe erythema (large)	There are rashes on the human body. The skin and mucous membranes are affected. The patient complains of a deterioration in general health.

Exudative erythema multiforme can develop for a long time, while a person develops concomitant diseases. Therefore, differential diagnosis is necessary in order to correctly establish the diagnosis.

Complications and prognosis

Negative consequences of a person await if he refuses therapy or the wrong means are selected for him. At home, you cannot treat erythema multiforme on your own. The disease requires careful diagnosis and a properly selected therapy regimen.

Forecasts in most cases with erythema multiforme are favorable, only complex forms provoke serious complications:

• prolonged fever;
• bleeding;
• keratitis;
• development of conjunctivitis;
• meningoencephalitis;
• myocarditis.

Lack of medical attention can be fatal. Therefore, you can not delay going to the doctor dermatologist.

Diagnostics

A comprehensive examination with the appearance of exudative erythema multiforme will not only determine the cause of the disease, but also differentiate it. Many pathological processes are accompanied by similar clinical signs (stomatitis, herpes, pemphigus, syphilis).

Comprehensive diagnostics includes the following tests:

Name	Description
General blood analysis	The erythrocyte sedimentation rate increases and moderate leukocytosis is present.
Cytological studies	The morphological structures of cells are assessed. The most informative diagnostic method that allows you to identify malignant processes.
Allergic tests	A number of tests are performed to help identify the allergic source.
Histological examinations	In the laboratory, specialists study a skin biopsy.

The results obtained will also help the doctor choose the most effective treatment method, taking into account all the individual characteristics of the patient. You should not take medications or use other methods of therapy on your own, you can aggravate the course of the disease. In case of damage to the mucous membranes, the patient is additionally assigned a consultation with an otolaryngologist or ophthalmologist.

Treatment

Erythema multiforme exudative (differential diagnosis will help exclude the likelihood of developing other pathologies) is treated with complex methods, taking into account the results of analyzes after conducting a thorough survey. Therapy is aimed at reducing the severity of the symptoms of the disease, reducing the duration of relapse, and preventing complications.

Medicines are selected by a doctor, it is important to strictly adhere to the established dosages in order to reduce the risk of side effects:

Drug group	Name	Application
Antihistamines	Tavegil, Suprastin	The preparations eliminate allergic symptoms (itching, skin redness). The medicine is recommended to be taken orally without chewing and drinking plenty of water. The adult dosage is 0.001 g 2 times a day.
Antiseptics	Furacilin, Chlorhexidine	Medicines irrigate and treat mucous membranes. They inhibit bacterial growth and reduce inflammation. The tablets are dissolved in a small amount of water and used to treat stains or erosions on the body.
Keratoplastic drugs	Salicylic acid, Resorcinol	Medicines accelerate the regeneration of damaged cells. The drug is applied to the affected areas on the body 2-3 times a day with a cotton swab.
Local enzyme preparations	Terrilitin, Karipazim	The products help remove plaque that has formed on erosions and necrotic tissue. The solution is diluted with water for injection and applied to the affected areas with a napkin. The procedures are carried out for 1-2 days.
Antiviral medicines	Acyclovir, Famciclovir	Drugs are prescribed to patients if pathological processes are provoked by viruses. Adult patients are prescribed 200 mg 5 times a day. The time interval should not be less than 4 hours. The course of treatment lasts 5 days.
Corticosteroids	Prednisolone, Hydrocortisone	The therapeutic dosage is 4-6 tablets per day. It should be divided into 2-3 doses. Maintenance therapy consists of 1 to 2 tablets per day.
Immunosuppressants	Dapsone, Hydroxychloroquine	The medicine is recommended to be taken after meals and washed down with plenty of water. On average, an adult patient is prescribed 1-2 tablets per day for 6 days a week.
Antibacterial drugs	Erythromycin, Amoxicillin	Medicines are prescribed in the event of a secondary infection. The tablets should be drunk before meals for 1.5 hours or after a meal after 2 hours. The adult dosage is selected individually in each case and is 200-500 mg 4 times a day. The course of therapy lasts 5-14 days.
Anti-inflammatory drugs	Nimesil, Indomethacin	The medicine is recommended to be taken after meals. Adult patients are prescribed 100 mg 2 times a day.

Desensitizing therapy is mandatory. Hospitalization is indicated for patients in difficult situations or with the appearance of serious complications. The same goes for the ineffectiveness of medical treatment.

Diet

Erythema multiforme exudative (differential diagnosis will allow to determine the cause of the disease and select treatment) requires complex therapy, where one of the main places belongs to the dietary nutrition. It is necessary to exclude from the diet all foods that increase the allergic reaction and symptoms of the disease. A dietitian will help you compose the menu.

Allowed Products	Prohibited foods
Uncooked bread; lean beef; fermented milk products; vegetable soups; weak broths; baked apples and watermelon; fresh cucumbers; cereals; cherry, plum and apple compote; dried fruits.	Mushrooms and eggplants; citrus; nuts; poultry meat; Fish and seafood; smoked and spicy dishes; chocolate products, honey; flour and butter dishes; strong coffee; alcoholic drinks.

If characteristic rashes appear in the oral cavity on the mucous membrane, it is better to eat food in liquid form in order to reduce irritation of the inflamed epithelium. We must not forget about the drinking regimen, it is also recommended to use herbal decoctions, which relieve inflammation well.

Folk remedies

Exudative erythema multiforme is a serious condition that cannot be treated without traditional medical attention. In complex therapy, you can use folk remedies, but it is important to select the recipes of healers and healers with a dermatologist. The herbs and plants used can aggravate an allergic reaction or cause complications.

Name	Recipe	Application
Arnika (ram)	Grind the flowers of the plant and pour hot water (200 ml) overnight. Leave in a thermos overnight.	The filtered broth is recommended to be consumed orally for 1 tsp. l. 5 times a day on an empty stomach.
Herbal collection	Mix in equal parts lingonberry leaves, immortelle, lemon balm, mint, birch and yarrow. Pour 1 tbsp. l. herbal collection with boiling water (500 ml). Insist and strain.	The ready-made broth should be drunk 15 minutes before meals. 1/3 st.
Red elderberry	Dry grass (10 g) is poured with vodka (0.5 l). The resulting mixture is infused for 40 days.	The tincture should be taken in 20-30 drops, depending on body weight, once a day before bedtime. You can have a snack with a small piece of black bread with sunflower oil. The course of treatment lasts a month.

Elderberry, hawthorn and rosehip berries are also used in the fight against exudative erythema multiforme. A decoction is prepared from them and taken 2 times a day, in the morning and in the evening. It is important that the treatment is carried out in a comprehensive manner, it is impossible to get rid of erythema with folk remedies alone.

In 30% of cases, exudative erythema multiforme reappears. The reason may be various provoking factors, including not fully carried out therapy, lack of preventive measures. It is important to carry out differential diagnosis at an early stage in the development of the disease in order to stop the progression of pathological processes and prevent serious consequences.

Video about erythema multiforme exudative

Erythema multiforme exudative: