Erythema multiforme mkb 10. Erythema exudative multiforme
Erythema nodosum ICD-10 is a skin disease from the group of deep cutaneous angiitis, which has a unique number after the 10th revision. Simply put, this is an inflammation of adipose tissue in the skin and its other layers, which occurs both as an independent disease and as one of the symptoms of more serious internal pathologies. Erythema nodosum ICD-10 should be treated exclusively in accordance with the doctor's prescription.
Disease code
In accordance with the International Classification of Diseases of the 10th revision, a unique code is assigned to this disease: L52. Erythema nodular is included in the subclass "Urticaria and erythema" (code L50-54), as well as the class "Diseases of the skin and subcutaneous tissue" (code L00-L99).
Symptoms
The disease occurs in acute and chronic forms. Generally, there is general weakness, muscle aches and joint pain.
The acute form of erythema is characterized by:
This form of pathology is more typical for young women and children after a severe sore throat. Does not occur again.
The chronic form is divided into several more varieties: migratory (long-developing) and superficial-infiltrative. It manifests itself:
This type is found in females of the middle and elderly age category.
Erythema nodosum (or nodose) is considered adolescent disease. It is more common in girls, less often in boys.
Basically, erythema is expressed as a sign of one of the following diseases:
In rare cases, nodules appear while carrying a baby. Under this condition, it is worth contacting a doctor for an examination.
Those with hypertension are at risk.
The definition of the disease consists in examining the affected areas of the body and the results in terms of histopathology: the state of small skin vessels, the accumulation of some substances produced by the body around them, the study of the reticular layer of the dermis for density and proliferation.
First of all, the likelihood of infection with tuberculosis is studied. If the diagnosis is confirmed, appropriate therapy is prescribed.
Small children are prescribed aminocaproic acid. For different ages, the drug is selected in the form of a solution, syrup or tablets.
In the case of a severe stage of the disease, hormonal drugs along with antibiotics.
To strengthen the body and fight inflammation from the inside, vitamins are prescribed: ascorbic acid, aevit, autohemotherapy and more.
As physiotherapy, it is possible to irradiate with a mercury-quartz lamp, UHF, diathermy.
For external use, decongestant compresses are prescribed.
Erythema nodosum
Definition and background [edit]
Erythema nodosum
At the heart of erythema nodosum is damage to blood vessels by immune complexes, which include bacterial antigens. Women get sick 3-6 times more often than men, the peak of the disease occurs at the age of 20-30 years. The elements are selectively localized on the anterior surface of the legs, ankle and knee joints.
Etiology and pathogenesis [edit]
Pathohistology
The pathohistological structure of cutaneous angiitis is quite the same: swelling of the endothelium of blood vessels, infiltration of the vascular walls and their circumference by leukocyte cells (neutrophils, eosinophils, lymphocytes, histiocytes), leukocytoclasia (the presence of nuclear stenocyte nuclei debris among the cells of infiltration) vessels and their circumference, erythrocyte extravasates in the tissue, segmental necrosis of the vascular wall.
Clinical manifestations [edit]
Acute erythema nodosum- a classic, although not the most common variant of the disease. It manifests itself as a rapid rash on the legs (rarely on other parts of the limbs) of bright red edematous painful nodes the size of a child's palm against the background of general swelling of the legs and feet. Characterized by an increase in body temperature up to 38-39 ° C, general weakness, headache, arthralgia. The disease is usually preceded by a cold, an outbreak of sore throat. The nodes disappear without a trace within 2-3 weeks, successively changing their color to cyanotic, greenish, yellow ("blooming bruise"). Ulceration of nodes does not happen. No relapses are observed.
Chronic erythema nodosum(the most frequent form cutaneous angiitis) is characterized by a persistent recurrent course, usually occurs in women mature age... Exacerbations often occur in spring and autumn, characterized by the appearance of a small number of bluish-pink dense, moderately painful nodes the size of a forest or Walnut... At the beginning of their development, the nodes may not change the color of the skin, not rise above it, but be determined only by palpation. The almost exclusive localization of the nodes is the lower leg (usually their anterior and lateral surfaces). Moderate swelling of the legs and feet is noted. General phenomena are unstable and poorly expressed. Relapses last several months, during which some nodes can dissolve, and others appear to replace them.
Erythema nodosum migrans usually has a subacute, less often chronic, course and a peculiar dynamics of the main lesion. The process, as a rule, is asymmetric and begins with a single flat node on the anterolateral surface of the lower leg. A node of a pinkish-cyanotic color, a doughy consistency, rather quickly increases in size due to peripheral growth, soon turning into a large deep plaque with a sunken and paler center and a wide, valved, more saturated peripheral zone. The lesion persists from several weeks to several months. General phenomena are possible (subfebrile condition, malaise, arthralgia).
Erythema nodosum: Diagnosis [edit]
Diagnosis of angiitis of the skin in typical cases does not present significant difficulties. For a preliminary diagnosis of one form or another of cutaneous angiitis, a clinical examination of the patient and the collection of basic anamnestic data are usually sufficient.
As a rule, to confirm the diagnosis of angiitis, especially with a persistent course of the disease or its atypical variety, it is necessary to conduct a histopathological examination of the affected area of the skin.
Differential diagnosis [edit]
Erythema nodosum: Treatment [edit]
Erythema nodosum (subacute, chronic)
a) General treatment: Iodic alkalis (Potassium iodide 3% solution, 1 tablespoon 2 times a day)
b) Local treatment: Applications of dimethyl sulfoxide, occlusive dressings with butadione, glucocorticoid ointment.
Angiitis nodular
a) General treatment: Quinolines (Chloroquine at 0.25 g / day);
b) Local treatment: Glucocorticoid ointment; dry heat
Forecast
The prognosis for life with angiitis with isolated or predominant skin lesions is favorable. Acute variants usually have a cyclical course, are prone to spontaneous regression, and do not recur. In chronic forms, the prognosis is determined by the adequacy of therapy and prevention.
Prevention [edit]
In all cases of cutaneous angiitis with disappearance clinical manifestations disease treatment should not be completed. It should be continued in a reduced volume until laboratory parameters are completely normalized, and over the next 0.5-1 years, patients should be left on supportive treatment, for which angioprotectors are usually used, which improve microcirculation and rheological properties of blood, protecting the vascular wall from adverse effects: piricarbate or calcium dobesilate (0.25 g 2-3 times a day), antiplatelet agents (dipyridamole 0.025 g 2-3 times a day, xanthinol nicotinate 0.15 g 3 times a day), peripheral hemokinators (cinnarizine 0.025 g at night) or adaptogens (Siberian ginseng extract, 25 drops 2 times a day before meals). Patients should be warned about the need to comply with preventive measures that exclude exposure to risk factors (hypothermia, physical and nervous overload, long walking, bruises). In necessary cases, the employment of patients should be carried out, and sometimes they should be transferred to temporary disability. Patients should be advised a healthy lifestyle (morning exercises, hardening, water procedures, regular balanced meals, walking in the fresh air, swimming, adequate sleep).
Other [edit]
Ulcerative angiitis
In a broad sense, it can be considered as an ulcerative form chronic erythema nodosum... The process from the very beginning has a torpid current and is manifested by dense, rather large, slightly painful cyanotic-red nodes, prone to decay and ulceration with the formation of sluggish cicatricial ulcers. Skin over fresh nodules may be normal in color. Sometimes the process begins with a cyanotic spot, transforming over time into a nodular seal and an ulcer. After the healing of ulcers, flat or retracted scars remain, the area of which, during exacerbations, can become denser and ulcerate again. Typical localization is the posterior surface of the legs (gastrocnemius), however, the location of the nodes in other areas is also possible. Characterized by pasty legs. The process has a chronic recurrent course, observed in women of mature age, sometimes in men.
Sources (links) [edit]
Dermatovenereology [Electronic resource] / ed. Yu.S. Butova, Yu.K. Skripkina, O. L. Ivanova - M.: GEOTAR-Media, 2013. - http://www.rosmedlib.ru/book/ISBN9785970427101.html
Erythema infectious (fifth disease)
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ICD-10: L50-L54 - Urticaria and erythema
Chain in classification:
3 L50-L54 Urticaria and erythema
Diagnosis with the L50-L54 code includes 5 clarifying diagnoses (ICD-10 headings):
Contains 9 blocks of diagnoses.
Excludes: allergic contact dermatitis (L23.-) angioedema (T78.3) hereditary vascular edema (E88.0) Quincke's edema (T78.3) urticaria. giant (T78.3) newborn (P83.8) papular (L28.2) pigmented (Q82.2) serum (T80.6). solar (L56.3)
Source: http://mkb10.su/L50-L54.html
Types of erythema nodosum disease
Erythema nodosum comes in two forms:
Acute erythema nodosum appears against the background of fever, malaise. It is expressed in the form of rapidly developing, multiple, very large dermohypodermal nodes of oval outlines, hemispherical, slightly raised above the surrounding skin and painful on palpation. These nodes are localized on the anterior surface of the legs, knee and ankle joints.
Chronic erythema nodosum, in turn, is subdivided into several subspecies too, namely:
Causes of erythema nodosum
The causes of erythema nodosum are varied. It can be:
Erythema nodosum can be an independent disease, or a symptom of another disease, or a sign of a patient's oversensitivity to a particular drug.
In children, erythema nodosum may appear after a cold or sore throat (especially streptococcal).
Symptoms of erythema nodosum
Erythema nodosum is characterized by the presence of such signs as:
Diagnosis of erythema nodosum
A dermatologist diagnoses a patient with erythema nodosum based on its clinical manifestations. To determine the reasons that led to this disease, the doctor sends the patient for examinations, assigning him to undergo:
Treatment of erythema nodosum
The course of treatment of erythema nodosum must necessarily include:
To relieve inflammation, potassium iodide is prescribed to the patient.
Medication includes prescribing:
It is also useful for the patient to undergo a course of magnetotherapy, laser therapy, inductothermy, ultrasound therapy, make sessions of phonophoresis with hydrocortisone on the area of inflammatory nodes or affected joints.
Treatment of pregnant women with erythema nodosum is somewhat problematic, since many medications are contraindicated for them during this period.
The prognosis for the treatment of erythema nodosum is generally favorable for the patient.
However, it is important to remember that acute erythema nodosum can progress to a chronic form of the disease. For this reason, when identifying certain symptoms, it is imperative to consult a doctor to establish an accurate diagnosis and prescribe a course of treatment.
Prevention of erythema nodosum
Everything preventive measures to prevent the development of erythema nodosum consists mainly in timely reorganization of the body (from foci of chronic infection).
All about erythema nodosum: general concept, causes, symptoms, treatment
Reasons for the appearance
Erythema nodosum (ICD code 10 L52) is a systemic disease that affects the skin and subcutaneous fat. The etiology is not completely clear. Most often, a hereditary factor plays a decisive role in the development of pathology.... The appearance of erythema nodosum is explained by the emergence of an immune-inflammatory syndrome, which occurs against the background of exposure to certain factors.
The disease can develop independently - the primary form, or due to other pathologies - the secondary one.
There are the following non-infectious factors the appearance of erythema nodosum:
Other causes of an infectious disease include:
It has been found that erythema nodosum often becomes chronic in people who suffer from vascular disorders. These include varicose veins, atherosclerosis.
A specific reaction of the immune system is observed in the presence of concomitant diseases of an allergic nature ( atopic dermatitis, asthma).
A typical manifestation of the nodular form of erythema is the appearance of dense nodes in the subcutaneous tissue.... The diameter of such neoplasms varies from 5 to 50 mm. Above the nodes is smooth skin that turns reddish. They rise slightly above the main surface, but have blurred boundaries. This is due to the swelling of the surrounding tissues.
The nodes grow in size rather quickly, and then, reaching a certain diameter, they stop growing. The disease usually manifests itself as a pain syndrome, which can be of varying intensity. At the same time, itching is rarely noted on the skin. Within 3-5 days after the appearance, the nodes become denser. Gradually, the color of the epidermis above the formation changes from blue, reddish to green and yellowish.
Most often, nodes with erythema are formed on the lower extremities. In many cases, the legs are affected symmetrically, but there are also unilateral lesions.
Sometimes nodes of subcutaneous fatty tissue are found on other parts of the legs - thighs, buttocks, calves.
Other symptoms of erythema nodosum include:
After 3 weeks, the disease resolves. On the limb, where the nodules were previously located, areas with hyperpigmentation appear, and peeling of the skin is observed. Over time, these symptoms disappear completely.
Since the disease can occur against the background of other pathologies, all patients undergo a comprehensive diagnosis of the state of the body. It includes:
In the presence of erythema nodosum, consultation with several narrow-profile specialists is shown - a phlebologist, an infectious disease specialist, a pulmonologist.
Treatment
Treatment can be done at home... Disease therapy is carried out taking into account the reasons that led to its development.
Traditional methods
It is best to treat the problem in the traditional way using systemic and local means of action:
- Antifungal, anti-viral, or antibacterial drugs(Amoxiclav, Viferon, Fluconazole). Prescribed for an infectious cause of the development of the disease.
- Non-steroidal anti-inflammatory drugs. The most popular of them are Diclofenac, Movalis, Celecoxib.
- Corticosteroids (Prednisolone). Appointed when the NPC is ineffective.
- Aminoquinoline preparations. Applied if the disease has become chronic.
- Antihistamines (Suprastin, Loratadin). Used to reduce edema, eliminate itching.
- Physiotherapy - phonophoresis, UHF.
- A tablespoon of a mixture of horse chestnut leaves and sweet clover is poured with 220 ml of boiling water, and then kept in a water bath for 15 minutes. After half an hour, the liquid must be filtered. The medicine is taken one tablespoon three times a day. If desired, only one of the components is used to prepare a therapeutic agent.
- You can eliminate the inflammatory process if you eat a clove of garlic every day and seize it with a small amount of honey.
- It is necessary to take aloe leaves and twist them through a meat grinder (the age of the plant is more than 3 years). Lemon juice and natural honey are poured in the same amount. If desired, you can add some finely chopped walnuts. To achieve a positive effect, before each meal, you must eat a tablespoon of the medicine.
- Regular consumption of vitamin teas. Positive effect beverages from rose hips, lingonberry leaves, raspberries, currants possess.
- fever, joint pain;
- increased ESR;
- recurring seasonal manifestations;
- swelling of the feet and localization of the rash (2-4 cm in diameter) in the lower legs (less often the thighs);
- combined with allergies and chronic infections;
- in some cases, knots are broken;
- exacerbation continues for several months.
- Tuberculosis.
- Streptococcal infections.
- Lupus erythematosus.
- Syphilis.
- Rheumatoid arthritis.
- Oncology.
- Colitis.
- Crohn's disease.
- the possibility of tuberculosis is excluded. With positive tests, the necessary treatment is prescribed;
- an examination for rheumatism is carried out. Antibiotics are prescribed, treatment is carried out under the supervision of a doctor;
- babies are prescribed aminocaproic acid, which, depending on age, is offered in the form of tablets, syrup or solution.
- If the disease is severe, then the patient is prescribed hormonal drugs in conjunction with antibiotics.
- Vitamin therapy (ascorbic acid) and autohemotherapy help to strengthen the immune system and fight the inflammatory process from the inside.
- Physiotherapy courses are conducted using UHF, irradiation with a mercury-quartz lamp.
- Special compresses help relieve puffiness.
- Experts suggest that patients adhere to a special diet.
- Patients are prescribed bed rest.
- inflammatory and infectious diseases of viral or bacterial origin;
- skin burns (sun, radiation, chemical);
- allergic erythema - a consequence of exposure to the body of allergens;
- autoimmune diseases (systemic lupus erythematosus).
- a serological study to detect the presence of antibodies to the virus that caused the disease;
- a general blood test to determine the number of formed elements;
- allergy tests;
- taking exudate from the pustules, if any.
- Symptomatic (emotive)
- Persistent
- Persistent ash dermatosis of Ramirez (dyschromic erythema)
- Palmar - erythema of the palms (palmar congenital, "hepatic palms")
- Polymorphic
- Erythema multiforme (+ Stevens-Johnson erythema)
- Physiological
- Viral
- Infectious
- Erythema Chamera
- Centrifugal erythema Bietta
- Centrifugal erythema Darier
- Solar (ultraviolet)
- Ultraviolet
- Fixed
- Annular rheumatic
- Knotty
- Nodose
- Cold
- Thermal
- Erythema Miliana
- Beam
- Sinuous erythema of Gammel
- Edged
- temperature increase;
- sore throat, itchy nose;
- runny nose;
- headache;
- the appearance of rashes (spots) on the body and oral mucosa after 2 or 3 days.
- cessation of exposure to radiation;
- a cool shower and cold lotions on the affected area;
- dexpanthenol-based sprays.
- Minutes of the meetings of the Joint Commission on the Quality of Medical Services of the Ministry of Healthcare of the Republic of Kazakhstan, 2016
- 1) Order of the Ministry of Health of the Republic of Kazakhstan No. 473 dated 10.10.2006. "On the approval of the Instructions for the development and improvement of clinical guidelines and protocols for the diagnosis and treatment of diseases "; 2) Anisimova I.V., Nedoseko V.B., Lomiashvili L.M. Diseases of the mucous membrane of the mouth and lips. - 2005 .-- 92 p .; 3) Diagnostics in therapeutic dentistry: Textbook / T.L. Redinova, N.R. Dmitrakova, A.S. Yapeev et al. - Rostov n / D .: Phoenix, 2006.-144s .; 4) Diseases of the oral mucosa and lips / Ed. Prof. E.V. Borovsky, professor A.L. Mashillison. - M.: MEDpress, 2001. -320 p .; 5) Zazulevskaya L.Ya. Diseases of the oral mucosa. A textbook for students and practitioners. - Almaty, 2010 .-- 297 p .; 6) Langle R.P., Miller K.S. Atlas of Diseases of the Oral Cavity: Atlas / Translated from English, ed. L.A. Dmitrieva. - M .: GEOTAR-Media, 2008. -224s .; 7) Therapeutic dentistry. National leadership. Moscow, Geotar-Media, 2009, 908s .; 8) Barer G.M. therapeutic dentistry. Part 3. Diseases of the oral mucosa. Publishing group "GEOTAR - MEDIA", 2008. - 288 p .; 9) Borovskiy E.V., Mashkillayson A.L. Diseases of the mucous membrane of the mouth and lips. Moscow, 2001 .-- 168 p.
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Traditional methods
Folk remedies are no less effective in the treatment of erythema nodosum than pharmaceutical medicines... Most popular recipes:
Possible consequences
By itself, erythema rarely leads to dire consequences. But very often it is a sign of more serious pathologies that require immediate medical intervention.
If dense nodules appear on the surface of the skin, it is necessary to pass comprehensive examination organism and establish the exact reasons for the development of pathology.
Sometimes erythema can recur. But this does not pose a serious danger and responds well to treatment.
Prevention of the disease consists in the timely treatment of concomitant diseases that negatively affect the work of the whole body. You should eat right, give up bad habits, avoid stress, which will have a positive effect on immunity. Patients who have undergone this disease are advised to avoid too intense solar radiation for some time, to prevent cooling.
Given the variety of reasons for the development of erythema nodosum, the choice of treatment and prevention methods is difficult. But an integrated approach to the problem and a timely visit to a doctor will prevent unwanted consequences.
Erythema nodosum
Erythema nodosum- the disease is quite common, especially among pregnant women. The disease is characterized by the presence of medium-sized nodules (from one to three centimeters in diameter), which are most often located in the lower leg, but can in other cases also occur on the thighs, buttocks, and arms. Typically, these nodules occur symmetrically on both limbs. The nodules themselves also have characteristics- they are hot to the touch, slightly rise above the surface, the skin on top of the nodules is thinned, its surface shines. When pressed, soreness is felt.
Usually, before or during the appearance of an erythematous rash, there is a fever, a general malaise similar to the precursors of flu, and joint aches.
During the course of the disease, erythema nodosum undergoes some changes. At the initial stage, the barely pink nodules rapidly increase in size and change color from light pink to bright purple. After about a week, the nodules turn purple, and already in the stage of remission, the process resembles ordinary bruises - first a greenish-yellow tint appears, which in its residual form stains the skin brown. This pigmentation is very slow.
Causes of erythema nodosum
The appearance of erythematous nodes on the extremities is only a manifestation of the disease, the causes of which lie much deeper. For a long time, it was not possible to identify the cause of erythema nodosum, and in fairness it should be said that even now the causes of erythema nodosum are not fully understood, but the factors provoking its appearance have been considered. At risk are women who are taking hormonal contraceptives and pregnant women.
Among these factors, it is worth noting the introduction of a bacterial antigen by injection. European doctors have confirmed the connection of erythema nodosum with tuberculosis, American - with streptococcal infection... Sarcoidosis, histoplasmosis, and yersiniosis can provoke the disease. Also, erythema can be a response to taking medications, especially contraceptives.
The state of blood vessels is of great importance in the appearance and clinical picture of the disease. lower limbs... Doctors have proven that most often erythema appears in those women who suffer varicose veins, thrombophlebitis. Note that such problems with blood vessels most often occur during pregnancy, which is why this factor increases the frequency of manifestations of erythema nodosum in pregnant women.
The appearance of erythema nodosum manifests itself in a typical clinical course in inflammatory diseases. The blood test reveals increased speed erythrocyte sedimentation. Usually, when erythema nodosum appears, doctors do tests for diseases such as tuberculosis, lupus erythematosus, stomach and intestinal diseases. Sowing cultures from the pharynx is mandatory to detect streptococcus.
In other cases, erythema nodosum can be an independent disease. Then the identification of the cause becomes impossible.
Forms of the disease
Erythema nodosum can occur in two forms: acute and chronic. Depending on which form is diagnosed, the manifestations of the disease also differ.
In acute form body temperature rises to high levels - about thirty-nine degrees. Patients shiver, there are painful sensations in the joints, in the neck, hips, shoulders. Already at the initial stage of the acute form, it is possible to notice seals under the skin, which do not have clear edges. Most often, erythema in acute stage immediately manifests itself in bright red spots, and only then the pigmentation changes depending on the stage of attenuation of the process. This usually takes about one month. Acute erythema most often affects girls, especially those who are sensitive to the tuberculin test.
In chronic form it is possible to distinguish such a subspecies of erythema nodosum as allergic vasculitis. It is characterized by a long course with frequent relapses, a small number of nodes that practically do not disintegrate (the color does not change). In the same subspecies, Beverstedt's wandering erythema is distinguished, in which the erythema focus appears and fades, and new nodes appear around it, which do not change their color.
Treatment of erythema nodosum
To get rid of the general symptoms of erythema nodosum, salicylates and wide range antihistamines (diazolin, suprastin, zirtek, tavegil, telfast, claritin). Antibiotics may be prescribed depending on what the tests show. It is strictly forbidden to self-medicate erythema, and even more so to take antibiotics on your own - medications can lead to serious allergic manifestations and complications in the gastrointestinal tract.
Lumps on the skin are often treated with corticosteroids, but their use is limited by some features. For example, against the background of an infectious disease, it is better not to use these drugs.
Patients with erythema nodosum are placed in bed rest. Physiotherapeutic methods of treatment are widely used - phonophoresis, warm compresses on the lower leg, ichthyol warming compresses, UHF, diathermy. After a course of drugs for local symptomatic treatment, immunity-strengthening therapy is performed. It is recommended to refrain from spicy, fried and fatty foods, preservatives, allergens.
Erythema nodosum in children
Erythema nodosum does not yet have its clearly defined causes, therefore, the approaches to this disease are different. For the etiology of erythema nodosum in childhood most often, a viral component is proposed, in which erythema nodosum is perceived as agglutination with a viral antigen. In children of the neonatal period and the thoracic period, erythema nodosum may be the result of tuberculous intoxication (allergic response), and at an older age we can say that this is a reaction to streptococci, staphylococci, candida. Wherein great importance has the presence of pathogenic microorganisms in the intestinal flora. In some cases, erythema nodosum is an oversensitive response child's body for antibiotics, iodine, barbiturates, sulfonamides, and other drugs.
Most often, the disease worsens in the spring-autumn and winter periods.
The clinical picture in children is not much different from that of an adult. Upset stomach can be added to all symptoms. In some cases, in children, erythema nodosum can soften, fester and subsequently resolve without severe local consequences.
In the treatment of erythema nodosum in children, when tuberculous etiology is not confirmed, drugs such as brufen, calcium gluconate, rheopyrin, naprosyn, aminocaproic acid are used. Among the ointments, Vishnevsky's ointment, ichthyol ointment, and acemin are recommended. It is very important at the time of therapy to increase the child's immunity. For this, vitamins are prescribed, such as rutin, aevit, B vitamins.
Usually, erythema nodosum in children gives positive dynamics already in the first week of treatment of the disease and, on average, resolves up to two weeks, and the skin color is restored within up to two months, depending on the severity of the process. If erythema nodosum appears again, its characteristics change (the severity of the course, duration, the occurrence of suppuration), then a more thorough examination is necessary for rheumatism, gastric diseases, tumor neoplasms, and tuberculosis.
Erythema nodosum in pregnant women
Erythema nodosum in pregnant women was previously perceived by doctors rather negatively. In textbooks for doctors of that time it was written that erythema nodosum threatens congenital malformations fetal development, therefore, termination of pregnancy was prescribed. For the sake of fairness, it should be noted that even now some doctors sin with excessive categoricality regarding erythema nodosum in pregnant women.
First of all, when erythema nodosum appears in a pregnant woman, doctors carry out diagnostic measures to identify the causes of the disease, such as tuberculosis, abnormalities from the gastrointestinal tract, Behcet's disease, and so on. Most often, these diseases are not the causes of erythema in pregnant women, which greatly facilitates the fight against the disease.
Today it has been established that erythema nodosum is more harmful to the health of the woman herself - there is a complication in the heart, and for a child such factors are almost invisible. In this case, doctors can prescribe a preservation if there are failures from the outside of cardio-vascular system... In some pregnant women, erythema nodosum may resolve by the end of the second or third trimester.
If there are no complications, then local treatment is indicated: foci of erythema nodosum are lubricated with indovazine, courantil is taken orally and paracetamol in small doses. To reduce inflammation, you can take aspirin in small doses and inject diclofenac, use Deep Relief ointment.
Erythema nodosum is a skin disorder in which subcutaneous adipose tissue is affected and inflamed, accompanied by a rash. In 30% of cases, it is impossible to find out the reason, which is the basis for considering it an independent disease.
According to the 10th revision of the International Classification of Diseases (ICD), the disease erythema nodosum received its unique code - L52. Among the many skin pathologies, it is represented by a subclass in the group with the code L50-54 ("Urticaria and erythema").
Symptoms of erythema nodosum
There are two forms of this skin pathology: chronic and acute. In both cases, symptoms are present: general weakness, muscle and joint pain.
The main symptoms of acute erythema nodosum
Acute is more common in girls in childhood and adolescence, and the male half gets sick less often. Disease progression often occurs in spring or autumn.
Signs of the disease:
This form occurs in children after a complex sore throat. No repeated cases have been observed.
Chronic erythema
Chronic erythema nodosum of the ICD-10 code is of two types: migratory (longer, recurrent) and superficial-infiltrative (large).
It manifests itself in the following symptoms:
This type of pathology is usually found in older women.
Causes
Erythema is a consequence of existing diseases, including:
In some cases, a nodular rash appears during pregnancy or after taking certain medications. For additional examination and analysis, you must contact a medical institution. Hypertensive patients represent a special risk group.
The examination of the skin and the results of the histopathology helps to make the diagnosis. The reticular layer of the skin (density, proliferation) is checked, the state of the vessels is studied.
When diagnosing, it is important to pay attention to the symmetry of the nodes that have appeared. The skin has a bluish tint, which changes according to the principle of "blooming bruise". The resulting nodes do not disintegrate, and ulceration does not form on the skin.
Treatment
The treatment regimen is as follows:
Prophylaxis
After taking appropriate measures and removing the rash, treatment does not end. It is continued until laboratory test results show a normal state. In the future, supportive therapy is carried out for several months. For this, angioprotectors are used, which protect the vessels of the skin from adverse effects.
Exudative erythema multiforme (erythema multiforme)- an acutely developing disease characterized by the appearance of erythematous spots, bullous lesions of the skin, mucous membranes, and a cyclic recurrent course.
Code by international classification diseases ICD-10:
Statistical data... The incidence is 0.3-0.5: 100,000 population, 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 hypersensitivity to drugs. Exudative malignant form (see Stevens-Johnson Syndrome). Rheumatic erythema - rounded or arcuate foci of erythema on the trunk and limbs, sometimes observed with rheumatic attack.
Symptoms (signs)
Clinical manifestations... Local symptoms .. On the skin of the extensor surfaces of the forearms, legs, back of the hands and feet, face, genitals, on the mucous membranes, symmetrical rashes appear sharply. Edematous, clearly delimited, flattened pink-red papules of a rounded shape appear, with a diameter of several millimeters to 2-5 cm, having two zones: an internal (grayish-cyanotic color, sometimes with a bladder in the center filled with serous or hemorrhagic contents) and an external (red [cockade-like rash]) .. On the lips, cheeks, palate there are diffuse erythema, blisters, erosive areas covered with a yellowish-gray coating. General symptoms .. Burning and itching in the area of the rash, 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. In the toxic - allergic form, in contrast to the idiopathic form, there is no seasonality of relapses of rashes.
Diagnostics
Research methods... Carry out laboratory research to exclude syphilis - serological reactions, studies for treponema pale. Symptoms of Nikolsky, Asbo-Hansen are negative, there are no acantholytic cells in smears - prints. During histopathological examination, intracellular edema, hydropic degeneration of basal cells are noted in the epidermis, edema of the papillary layer, perivascular infiltrates in the dermis.
Differential diagnosis... Chicken pox. Bullous pemphigoid. Dermatitis herpetiformis Duhring. Herpes zoster. Syphilitic papular eruptions.
Treatment
Treatment... With a mild course - antihistamines and desensitizing agents. For blisters and erosions on the skin - ointments with HA and antibiotics (for example, oxytetracycline + hydrocortisone). In case of lesions of the oral mucosa - warm rinses with 10% p-rum of sodium bicarbonate, local anesthetics (2% p-p lidocaine), as well as GC: dexamethasone (elixir, 0.5 mg per 5 ml of water) 4 r / day followed by swallowing. In more severe cases and with widespread bullous forms, antibiotics (by mouth or parenteral), GC (for example, prednisolone 1-2 mg / kg / day with subsequent dose reduction), inhibitors of proteolytic enzymes (aprotinin). With Stevens-Johnson syndrome - see Stevens-Johnson syndrome.
Forecast... The outcome of the disease in uncomplicated cases is favorable. With Stevens-Johnson syndrome, the mortality rate is 10-30%.
ICD-10. L51 Erythema multiforme
Redness of the skin in medical terminology is denoted by the word erythema. It can be caused by natural harmless factors - an increase in air temperature, bathing in hot water, or physical impact. But a change in the color of the skin to red for no obvious reason is a signal of pathological processes in the body that require seeking qualified medical care.
This term of Greek origin ("erythros" - red) denotes a pronounced redness of the skin due to the expansion of capillaries. These small vessels are located directly in the skin, so the rush of blood to them is clearly visible externally. It may be one of the symptoms of an infectious-inflammatory process in the body, but often it also has purely physiological reasons that are not associated with any diseases.
Erythema should be divided into active, caused by an acute inflammatory process and passive, associated with blood stasis (venous stasis).
Causes of occurrence
Normally, redness of the skin is a temporary phenomenon that quickly passes after the elimination of the irritating factor (for example, caused by an emotional outburst). Pathological forms are characterized by persistence and duration, the main reasons for them are:
Among physiological factors redness can be highlighted by ingestion or topical use of certain medications (for example, warming ointments), physical effects such as flogging or massage, UV exposure to the sun preceding tanning. Reflex skin discoloration is caused by strong emotions (shame, anger), orgasm, and sometimes hypnotic suggestion.
The mechanism of development of the pathological process is determined by the action of the irritating agent. Viruses or bacteria provoke inflammation and general intoxication, accompanied by fever and blood flow to small vessels. With burns and allergies, redness appears due to the release of histamine into the bloodstream, which expands the capillaries and contributes to the stagnation of blood in them.
Diagnostics
It is quite difficult to diagnose one of the many types of erythema, since the characteristic redness of the skin and accompanying symptoms are characteristic of many diseases. For example, for, or. After making a preliminary, primary diagnosis, a dermatologist prescribes specific tests:
It is also necessary to preliminarily exclude the physiological causes of erythema and undergo differential diagnosis.
Erythema - photo, symptoms and treatment
There are more than two dozen varieties of this disease, and each of them has its own causes and external clinical signs. The type of redness and accompanying symptoms allow the dermatologist even with initial examination it is enough to reliably diagnose one or another type of erythema.
The following forms are distinguished:
The principles of treatment for a particular type of disease depend on the causes that caused it, the severity of the course, the patient's age and some other factors. In addition, physiological forms pass on their own and quickly, and do not require therapy.
The second name is emotive, which indicates its origin. Skin redness is triggered by intense emotions such as anger, shame, or stressful situations. It manifests itself in the form of a transient change in the color of the skin of the face, chest and neck to a pronounced red or crimson color. The vessels in this case expand for a short time due to the chemical reaction of stimulating cholinergic receptors.
Photo of symptomatic erythema
Persistent erythema
ICD-10 code L95.1. She is also a towering or Crocker-Williams erythema. A rather rare type of unclear etiology: the causes can be both vasculitis, infections, and heredity. The disease begins with the appearance of small papules, which subsequently merge into large (up to 7 cm in diameter) foci of uneven outlines with ridges along the edges. The color varies from pinkish to deep red, the surface is soft at first, then hardens and may peel off. NSAIDs, heparins, vitamins, antiplatelet agents, angioprotectors are prescribed. Large lesions are removed with cryotherapy.
Photo of a steadfast towering era. Persistent ash dermatosis of Ramirez (dyschromic erythema)
A rare variant of lichen planus, accompanied by the appearance of ash-gray spotty rashes.
No treatment has been developed. An independent spontaneous regression of the rash is possible.
Photo of the dyschromatic era. 
ICD-10 code L53.8. A characteristic symptom is pronounced redness of the palms. The pathological type of this phenomenon is most often caused by liver diseases, leukemia, rheumatoid arthritis, bacterial endocarditis and other pathologies. Acquired palmar erythema is also called a hepatic palms symptom.
It is sometimes seen in pregnant women, usually in the second trimester. In the photo of palmar erythema, it can be seen that mainly palmar eminences and fingerpads turn red. In the future, hyperemia covers the entire palm.
Subjectively, sensations of itching and pulsation are likely; when pressed, the skin turns pale for a while, then returns to a state of hyperemia. Treatment is prescribed in accordance with the cause of palmar erythema - cirrhosis, jaundice, arthritis.
Hepatic palms 
Erythema of the palms (palmar) Congenital palmar erythema is hereditary and is caused by the expansion of the capillary palmar anastomoses. The disease is not accompanied by other symptoms and does not require treatment.
ICD-10 code L51. An acute illness, often recurrent or chronic. The reasons can be both infections and toxic-allergic reactions of the body. It manifests itself as polymorphic rashes on the mucous membranes and skin, and they begin to appear strictly symmetrically on the limbs (back surfaces of the feet, lower legs and forearms). Bluish spots with a pink border up to 3 cm in diameter and small papules are formed. Soreness and itching appear, sometimes the general well-being worsens. The border of the lips is also involved in the process with the formation of bloody crusts later. The rash lasts for about a week, after which the blisters dry up and the spots disappear.
Multiforme exudative era. on elbows 
In some cases, the disease proceeds in a vesiculobullous form (Stevens-Jones erythema), characterized by a severe course and a high risk of death.
Erythema Stevens-Johnson 
Er. Stevens-Johnson on the face Polymorphic erythema
Synonym for erythema multiforme. Characterized by multiple rashes different types: papules (nodular rash), vesicles (medium-sized fluid-filled blisters), hemorrhages - punctate intradermal hemorrhages and others. Their appearance is accompanied by symptoms of general intoxication.
The reason usually becomes a negative reaction of the body to the drug in case of intolerance. The progression of the disease leads to the spread of mucous membranes and fusion of the rash with the formation of large blisters. Treatment involves the abolition of the allergen drug, the introduction of antihistamines, glucocorticoids, wound healing drugs, vitamins. Therapy of cardiovascular syndrome is carried out, if any.
Physiological erythema
ICD-10 code P83.1. From the name it is clear that this phenomenon does not mean a painful condition, it passes quickly and does not require treatment. In adults, it appears as a result of physical effects on the skin or reflex nervous reactions. Physiological erythema is also distinguished, which appears in infants a few hours or days after childbirth (sometimes with minor rashes of a gray-yellow color). It is explained by the peculiarities of adaptation of the child's body in the postpartum period.
The reason for the physiological erythema of newborns is, first of all, the temperature difference: in the womb it is higher and more constant, therefore, its decrease leads to an increase in peripheral blood circulation and, accordingly, temporary redness. No treatment is required, since it passes in a day. The second factor causing erythema on days 2 or 3 may be addiction to food through the gastrointestinal tract and the ingestion of allergens by this route. It also usually does not require therapy if no infection is detected. Antihistamines are sometimes given in drops to relieve itching.
Physiological era. newborn 
ICD-10 code L51.8. The reason for the development of the disease is the defeat of the body by a virus. Mostly children aged 4-2 years get sick, especially in the spring-autumn time. Viral erythema is quite easy to confuse with other infectious colds at the initial stage, since the symptoms are almost the same. The main symptoms of viral erythema in children include:
After a few days, the rash disappears, but the internal organs are already infected. Viral erythema in children, if not recognized in time, leads to disorders of hematopoiesis, damage to joints and bone marrow, anemia. Treatment is carried out with antiviral drugs, analgesics. Topically applied ointments Lorinden ®, Advantan ®.
Infectious erythema
ICD-10 code B08.3. The second name - "the fifth childhood infection", is caused by parvovirus B19. It occurs very often in children, while in most cases it is asymptomatic or mild. The incubation period is up to 2 weeks, after which the first and main symptom appears - a pronounced redness of the cheeks. Then a characteristic "lace" rash appears all over the body, which disappears no later than after 2 weeks. Treatment is predominantly symptomatic and immune-supportive. In adults, the disease is more severe, parvovirus is especially dangerous for pregnant women.
Erythema Chamera
ICD-10 code L53. Variety infectious form a disease that occurs in children and adults. It is characterized by a rather mild course with minor symptoms of intoxication and fever. In the photo of Chamer's erythema in children, it can be seen that the rashes that appear on the first day from the onset of the disease merge on the second day into an extensive spot of a specific shape.
The reddened areas have a butterfly outline. Erythema of Chamera in children completely disappears within 2 weeks, while it is treated exclusively symptomatically, if necessary. It is easily tolerated by adults, and usually occurs in a worn-out form, sometimes with slight swelling of the joints.
Centrifugal erythema Bietta
ICD-10 code L93. This is the name of a rare superficial type of lupus erythematosus. In this case, this autoimmune disease manifests itself in the form of redness diverging from the center of the face to the edges (a symptom of a "butterfly"), not accompanied by subjective unpleasant sensations. It stands out as a separate disease, but it can be one of the signs of systemic damage to the body. It is treated with antimalarial drugs, B-group vitamins, antioxidants.
Centrifugal erythema Darier
The disease is also called arcuate persistent erythema. The exact reason for its development has not been established. Viral, fungal and bacterial theories are not excluded.
Erythema is characterized by the appearance of small pinkish nodules on the skin of the trunk (less often of the face) due to retraction in the center, similar to rings.
Treatment includes therapy for the underlying disease, taking antihistamines and glucocorticosteroids.
ICD-10 code L55. This diagnosis is a consequence of prolonged exposure to the sun and exposure to UV rays of exposed areas of the body. As a result, the skin turns red for several hours, touching causes pain, slight swelling and an increase in total temperature body. Treatment of solar erythema is reduced to the following measures:
If the lesion is more severe (blistering), it is advisable to see a dermatologist. He will prescribe anti-inflammatory and antihistamines, glucocorticoid ointments.
Patients with hypersensitivity to ultraviolet light and a tendency to form solar erythema are advised to always use a cream with a high SPF filter, regardless of the season.
Ultraviolet erythema
ICD-10 code L56. When exposed to the sun, it is considered synonymous with solar erythema, but it can also be caused by artificial sources (special devices, tanning beds, etc.). the symptoms are the same: skin hyperemia, soreness, a general deterioration in well-being. treatment consists in cooling the irradiated areas, using dexpanthenol in the form of an aerosol.
ICD-10 code L53. It is the body's response to the ingress of a certain substance into the bloodstream, in relation to which there is hypersensitivity. A feature of this disease is the appearance of redness always on the same area of the skin or mucous membrane. Most often, areas of natural folds, genitals, face are affected. In the photo of fixed erythema, it can be seen that the spot is forming an extensive, red or cyanotic hue, sometimes with blisters and accompanying erosions.
Therapy of the disease always begins with the detection and abolition of the provoking factor (most often these are NSAIDs, antibiotics, hormonal agents). Further treatment of fixed erythema involves infusion therapy, intake of enterosorbents and external use of steroids. Extensive erosive lesions require the use of combined antimicrobial and wound-healing ointments, systemic corticosteroids.
Annular erythema
Code according to ICD-10 L53.1. Under this concept, a group of dermatological diseases similar in external manifestation is united. Characteristic common feature- ring-shaped or closed formless redness on the body, with peeling, vesicles or without them. Depending on the specific form of the disease, infections, helminthiases, weakening of the immune system, tonsillitis, mycoses, hormonal disruptions and oncological diseases can become the cause.
Most often, erythema annulus is rheumatic in nature.
Treatment is prescribed according to the underlying diagnosis.
Photo of the annular era. Toxic erythema
ICD-10 code L53.0. It is a consequence of the introduction of an allergen into the body, manifests itself in the form of hyperemic skin areas with an increase in their temperature. It is usually observed in newborns, full-term and breastfed. In adults, morbidity statistics are unknown, the cause may be exogenous (external) or endogenous (heredity, drugs, food) factors. It is stopped by taking antihistamines.
ICD-10 code L52. The name of the disease received in accordance with the main clinical symptom- the formation of multiple or single nodes in the skin of the legs. In the acute form, they are about 2 or 3 cm in diameter, pink or bluish in color, and are characterized by soreness (up to the inability to walk). The reasons are infections (most often streptococcal, toxoplasmosis, tuberculosis) or an allergy to medicines. Treatment is carried out in a hospital according to indications, depending on the provoking factor.
Photo of the knotty era. 
Erythema nodosa
ICD-10 code L52. It is synonymous with erythema nodosum, so the symptoms and etiology (causes of the disease) are the same. Treatment is also carried out in the same way - in a hospital according to the factor that caused the disease.
ICD-10 code L50.2. In response to a decrease in ambient temperature, persistent painful redness and rashes may appear on the skin. The reasons for this phenomenon have not been identified, presumably the process is triggered by special proteins that release histamine in the cold and cause allergic reaction... Chronic infections and weakened immunity can also be a trigger factor. There is no etiotropic treatment, antihistamines are prescribed, infectious diseases are detected and treated.
The disease is also called reticular telangiectatic dermatitis pigmentosa. Heat erythema develops with prolonged exposure to infrared radiation (fireplace, heating pads, etc.).
Treatment is reduced to eliminating the cause of erythema.
With this type of erythema, a distinctive feature is erythematous-desquamative rashes. The disease is characterized by a benign course and a favorable prognosis.
The cause of erythema is bacteria (staphylococcal and streptococcal flora).
The onset of the disease is always acute. There is a high fever, intoxication syndrome and a bright spotted rash. After the disappearance of erythema, profuse desquamation begins (especially on the palms and feet).
Differential diagnosis is carried out with scarlet fever.
Treatment includes antibacterial and anti-inflammatory therapy, and antihistamines are also indicated.
Erythema Miliana
ICD-10 code L53. The disease is an allergic reaction to parenteral administration of salvarsan, an outdated drug for syphilis. It manifests itself as a characteristic small-point scarlet fever or measles-like rash all over the body. Due to the fact that more modern and safer drugs have replaced salvarsan, this erythema does not occur.
ICD-10 code L58. This is the name of the redness of the skin in response to radiation in radiobiology. The reasons can be natural or artificial (used for the treatment of cancer and diagnostics) radioactive radiation. Early erythema occurs within 24 hours after irradiation, is characterized by slight hyperemia and passes quickly. True radiation erythema develops after a few days, is persistent, accompanied by soreness, swelling and itching.
Sinuous erythema of Gammel
ICD-10 code L53.3. Belongs to the group of patterned erythema, manifests itself in the form of winding stripes, resembling a cut of a tree and localized mainly in the face, neck, chest. It is a tumor marker, that is, it indicates the formation malignant tumor and requires appropriate treatment of the underlying disease. Erythema is observed in mammary adenocarcinomas, myelomas, pulmonary tumors, etc.
Bordered erythema
ICD-10 code L51.8. Another name - serum toxidermia, arises as a response to the introduction of serums into the body. The external manifestation is serous rashes or urticaria: a rash appears, bubbles filled with serous fluid on the skin. Treatment is symptomatic.
Code according to ICD-10 A69.2. Infection skin that develops after a tick bite and the bacteria Borrellia burgdorferi enter the body in this way. The incubation period, which lasts from 1 to 3 weeks, is replaced by the appearance of a ring-shaped erythematous spot, the boundaries of which are rapidly expanding.
Also called chronic erythema migrans or Lyme disease. A course of antibiotics is shown to destroy the pathogen and symptomatic treatment... In case of complications, Stevens-Johnson syndrome (ICD-10 code L51.1) or necrolytic erythema migrans, fraught with severe damage to the mucous membranes of the mouth, esophagus, genitals and eyes, develops. It is difficult to treat.
The disease is hereditary and has an autosomal recessive inheritance pattern. As a rule, males are ill. Bloom's erythema is extremely rare in women.
Characterized by the appearance of butterfly erythema (as in systemic lupus erythematosus) on the face, as well as red spots on the skin of the eyelids, ears, hands. In addition to facial erythema, patients have dwarf growth and signs of a dolichocephalic skull.
No treatment has been developed.
Congenital telangiectatic era. Bloom Consequences and predictions
The outcome for each type of disease is different. Infectious erythema, for example, goes away quickly and without any consequences. Toxic and migratory forms are life-threatening. Skin lesions heal, depending on the depth of the lesion, without a trace or with scarring. The prognosis also depends on the timeliness and correctness of the provision of medical care.
Prophylaxis
It is not entirely possible to exclude the development of erythema, however, to significantly reduce the likelihood is completely. Almost all types of this disease develop against the background of reduced immunity and chronic infections. That is, it is necessary to improve health and treat diseases in a timely manner. Erythema migrans will be protected from caution and protective measures in tick habitats.
RCHD (Republican Center for Healthcare Development of the Ministry of Health of the Republic of Kazakhstan)
Version: Clinical Protocols of the Ministry of Health of the Republic of Kazakhstan - 2016
Bullous erythema multiforme (L51.1), Non-bullous erythema multiforme (L51.0), Erythema multiforme (L51)
Dentistry
general information
Short description
Approved
Joint Commission on the Quality of Medical Services
Ministry of Health and social development Republic of Kazakhstan
dated August 16, 2016
Protocol No. 9
Exudative erythema multiforme - inflammatory disease the mucous membrane of the oral cavity and skin, characterized by a true polymorphism of the lesion elements associated with bacterial and drug allergies. It is characterized by an acute onset followed by a recurrent course.
The ratio of the codes ICD-10 and ICD-9:
Date of protocol development: 2016 year.
Protocol users: therapists, dermatologists, infectious disease specialists, allergists, dentists.
Evidence level scale:
| A | High quality meta-analysis, systematic review of RCTs, or large RCTs with very low likelihood (++) of bias that can be generalized to the relevant population. |
| V | High-quality (++) systematic review of cohort or case-control studies or High-quality (++) cohort or case-control studies with very low risk of bias or RCTs with low (+) risk of bias that can be generalized to the relevant population ... |
| WITH |
A cohort or case-control study or controlled study without randomization with a low risk of bias (+). The results of which can be generalized to the relevant population or RCTs with very low or low risk of bias (++ or +), the results of which cannot be directly extended to the relevant population. |
| D | Case series description or uncontrolled research or expert opinion. |
Classification
Classification:
· Infectious and allergic;
· Toxic and allergic.
Diagnostics (outpatient clinic)
DIAGNOSTICS AT THE AMBULATORY LEVEL
Diagnostic criteria:
Complaints: general weakness, headache, malaise, fever, pain in muscles and joints. Sore throat and mouth.
Anamnesis: with an infectious-allergic form, there are foci of chronic infection in the body, indications of the seasonality of relapses. With a toxic-allergic form, there are mandatory instructions for taking medications (sulfonamides, antibiotics). The course of the disease is recurrent, provoking factors - hypothermia, acute respiratory diseases, exacerbation chronic diseases, taking medications, nutritional errors.
Physical examination: upon visual examination on the skin of the palms, forearms, legs, feet, "cockades" are determined - a complex element consisting of a bluish-purple spot, a bubble or papule, a crust in the center. On the red border of the lips, hemorrhagic crusts are determined. On the mucous membrane of the oral cavity against the background of erythema, sharply painful erosions, ulcers, aphthae, subepithelial blisters and blisters are determined. With true polymorphism, false monomorphism is noted (erosion of all elements of the lesion). Nikolsky's symptom is negative.
Regional lymph nodes are enlarged, painful, not soldered to each other and to the surrounding tissues.
Laboratory research: general clinical analysis of blood, cytological studies (smear-imprint), allergic tests.
Instrumental research: no.
Diagnostic algorithm:
· Questioning;
· Visual inspection;
Palpation;
· Nikolsky's symptom.
Differential diagnosis
Differential diagnosis and justification for additional research:
| Diagnosis |
Rationale for differential diagnostics |
Surveys | Diagnosis exclusion criteria |
| Stevens Johnson Syndrome |
The presence of common clinical signs: general weakness, malaise, headache. Polymorphism you rashes on the skin and oral mucosa. |
Visual inspection |
The mucous membrane of not only the oral cavity is affected, but also the nose, eyes and genitals. |
| Medication stomatitis | Oral pain that gets worse with eating and talking |
Questioning |
In the history of the disease, a mandatory indication of the previous intake of medications |
| Acute herpetic stomatitis |
Violation of the general condition. Oral pain that gets worse with eating and talking |
Questioning Visual inspection |
No relapse. Erosion-prone erosion with polycyclic outlines. |
| Chronic recurrent herpes | Painful erosion in the oral cavity. |
Visual inspection |
General state not broken. Localization of small bubbles, prone to fusion, on the border of the skin and the red border of the lips. The resulting erosion has a polycyclic shape. Giant multinucleated cells in cytological examination. |
| Acantholytic pemphigus | Painful erosion in the oral cavity. Scabs on the skin. |
Visual inspection Instrumental research Cytological examination |
Erosion against the background of the mucous membrane of the oral cavity, little changed in color. Nikolsky's symptom is positive. Identification of Tzank acantholytic cells by cytological examination. |
| Secondary syphilis | Erosion on the oral mucosa |
Visual inspection Microbiological examination Serological reactions RIF (immunofluorescence reaction) RIBT (reaction of immobilization of pale treponema) |
No pain on palpation. The presence of an infiltrated base. In scrapings from erosion, pale treponemas are found. Positive result of Wasserman reaction and micro-reaction. RIF and RIBT are positive. |
Treatment abroad
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Treatment
Preparations ( active ingredients) used in the treatment
Treatment (outpatient clinic)
TREATMENT AT THE AMBULATORY LEVEL
Treatment tactics: General treatment includes the appointment of desensitizing drugs, anti-inflammatory therapy using salicylates.
Non-drug treatment: Mode III, Table 15.
Drug treatment(depending on the severity of the disease):
| Treatment stages | Medications | Mode of application | Purpose of application |
|
Local treatment |
Lidocaine 1-2% solution |
Applications 5 minutes | Anesthesia |
| 1% hydrogen peroxide solution | Mouth baths | Antiseptic treatment | |
|
1:5000 solution potassium permanganate |
Mouth baths | Antiseptic treatment | |
|
Prednisolone ointment 0.5% |
Applications | ||
|
Hydrocortisone ointment 1% |
Applications | Anti-inflammatory therapy |
Algorithm for emergency situations: no.
Other treatments: no.
Indications for specialist consultation: no.
Preventive actions:
· Sanitation of the oral cavity;
· Elimination of foci of chronic infection in the body;
· Reorganization of the body;
· The mode of work and rest;
· Treatment of chronic general somatic diseases.
Patient monitoring: patient observation card, individual patient observation card, individual plan action.
Treatment effectiveness indicators:
· Absence of relapses of the disease.
Information
Sources and Literature
Information
List of protocol developers with qualification data:
1) Yesembaeva Saule Serikovna - Doctor of Medical Sciences, Professor, RSE at the REM “Kazakh National Medical University named after S.D. Asfendiyarov ", director of the Institute of Dentistry, chief freelance dentist of the Ministry of Health and Social Development of the Republic of Kazakhstan, President of the Public Association" United Kazakhstan Association of Dentists ", head of the group;
2) Bayakhmetova Aliya Aldashevna - Doctor of Medical Sciences, Professor, Head of the Department of Therapeutic Dentistry of the Institute of Dentistry of the Republican State Enterprise on the REM “Kazakh National Medical University named after S.D. Asfendiyarov ".
3) Mazhitov Talgat Mansurovich - Doctor of Medical Sciences, Professor of JSC "Astana Medical University", Professor of the Department of Clinical Pharmacology and Internship, Clinical Pharmacologist.
No Conflict of Interest Statement: no.
Terms of revision of the protocol: revision of the protocol 3 years after its publication and from the date of its entry into force or in the presence of new methods with a level of evidence.
List of reviewers:
1) Zhanalina Bakhyt Sekerbekovna - Doctor of Medical Sciences, Professor of the RSE at REM West Kazakhstan State Medical University named after M. Ospanova, Head of the Department of Surgical Dentistry and Pediatric Dentistry;
2) Mazur Irina Petrovna - Doctor of Medical Sciences, Professor of the National Medical Academy of Postgraduate Education named after P.L. Shupik, Professor of the Department of Dentistry of the Institute of Dentistry.