MNOGOFORMNAYa (erythema exsudati vum multiforme; Greek erythema redness; lat. exsudare to come to light, to allocate; Gebra's synonym an erythema mnogoformny exudative)
— the acute disease observed preferential in the spring and in the fall, sometimes in the form of small flashes and shown in the form of peculiar erity on skin and mucous membranes.
Distinguish idiopathic and symptomatic E. aa. m. Idiopathic E. aa. the m has infektsionnoallergichesky genesis and arises at an aggravation of the centers of a persistent focal infection (e.g., tonsillitis), at inf. diseases (tularemia, leprosy, tinea profunda, etc.). Symptomatic E. aa. the m is shown as allergic reaction to nek-ry pharmaceuticals (sulfanamide drugs, antibiotics, etc.) and autotoksichesky substances (e.g., at disintegration of new growths).
At E. aa. the m is noted hypostasis and inflammatory infiltration of a derma, preferential around vessels. Infiltrates consist of neutrophils, lymphocytes, histiocytes and insignificant quantity of eosinophils, in their central part small hemorrhages quite often come to light. In epidermis intercellular hypostasis is expressed (see Spongiosas); at a vesical form subepithelial bubbles are formed.
The wedge, a picture is characterized by a rash of the small pink spots and small knots symmetrized on skin of the back of brushes and feet, an extensor surface of forearms, shins which are slightly towering over the surface of skin is more rare — on palms and soles, generative organs and quickly increasing in a size (to 3 — 5 cm in the diameter); in the next days the quantity them increases, they can merge. In 2 — 3 days the central part of spots slightly sinks down and becomes cyanotic color, and peripheral remains bright pink. At separate elements cyanotic color of the central part owing to the coming necrosis of epidermis passes in white, or the bubbles executed by serous more rare are in these parts formed by hemorrhagic exudate. In 2 — 3 weeks of a spot and small knots are resolved, and contents of bubbles dry up, forming crusts, to-rye quickly disappear. Quite often process recurs. Sometimes the mucous membrane of an oral cavity and a red border of lips are surprised, at the same time on an edematous erythematic background pour out large bubbles, to-rye are opened with formation of the painful and bleeding erosion. An enanthesis and mucous membranes can be followed by fervescence, a headache, joint pains and muscles.
In some cases the severe form E is observed. aa. m — Stephens's syndrome — Johnson, at Krom are sharply expressed the general phenomena (gektiches-ky fever), on skin and mucous membranes widespread rashes of preferential violent character are noted, conjunctivitis, a keratitis, stomatitis, an urethritis, a vulvovaginitis, pneumonia, an endocarditis develop.
Fissenzhe and Randyu (N. Fiessinger, R. Rendu) in 1917 described the syndrome (Fissenzhe — Randyu ektodermoz plyu-riorifitsialny erosive) proceeding also with sharply expressed feverish reaction and filmy (pseudomembranous) defeat of a conjunctiva of eyes and a mucous membrane of an oral cavity, a papulovezikulezny and violent enanthesis of extremities, a prepuce, a scrotum and a mucous membrane of a rectum; at this syndrome complications in the form of pneumonia and encephalomyelitis are possible. To the described syndromes it is close on a wedge, to a picture dermatostomatit Bader; it is shown by fervescence, heavy stomatitis with difficult separated plaque on mucous membranes and spotty and violent rashes on a red border of lips and skin.
The diagnosis is established on the basis by a wedge, pictures. Differential diagnosis carry out with a toxidermia (see), toksiko-allergi-cheskim an epidermal necrolysis (see the Necrolysis epidermal toxic), perfigeration (see), herpetiform dermatitis (see Dyuringa a disease); at the isolated damage of a mucous membrane of an oral cavity — with a vulgar pemphigus (see), various forms of stomatitis (see), erosive papules of the secondary period of syphilis (see).
Treatment is carried out by antibiotics of a broad spectrum of activity, drugs of calcium, antihistamines, redoxons, P, B2, appoint an autohemotherapy, in hard cases — corticosteroid drugs (Prednisolonum of 40 — 60 mg a day). Bubbles on skin puncture and process solution of aniline paint. At damages of a mucous membrane of an oral cavity appoint frequent irrigations by warm solutions of potassium permanganate (1:6000 — 1:8000), hydrosodium carbonate, 0,5% solution of novocaine.
The forecast is usually favorable, at Stephens's syndrome — Johnson the lethal outcome * is possible
Prevention consists in sanitation of the centers of a focal infection, in treatment of a basic disease, timely cancellation of medicines at emergence of signs of their intolerance. Bibliogrdifferentsialny diagnosis of skin diseases, under the editorship of. A. A. Stud-nitsina, page 76, M., 1983; Fish
of k of A. I. and Banchenko G. V. Diseases of a mucous membrane of an oral cavity, page 160, M., 1978; Lebedeva G. V. Erosive ektodermoz, Vestn. dermas, and veins., No. 10, page 40, 1960; Pashkov B. M., Stoyanov B. G. and Mashkille fico of N of A. L. Damages of a mucous membrane of a mouth and lips at some dermatosis and syphilis, page 81, M., 1970.
O. K. Shaposhnikov.