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},
"code": "L51",
"name": "Эритема многоформная",
"icd_name": "Эритема многоформная",
"gender": 0,
"age_min": 0,
"age_max": 100,
"cause": [
3,
0
],
"periodicity": 1,
"slug": "l51_eritema_mnogoformnaya",
"lead": "острое заболевание кожи и слизистых с полиморфными высыпаниями и наклонностью к рецидивам преимущественно в осенний и весенний периоды. ",
"description": "Многоформная экссудативная эритема возникает в основном у молодых людей и лиц среднего возраста.",
"etiology": "<p>К настоящему моменту не удалось выявить точные причины инфекционно-аллергической формы заболевания. Существует большая вероятность того, что причиной экссудативной эритемы является очаговая инфекция. Это может быть хронический аппендицит, пульпит, гайморит и пр. Этот фактор выявляется примерно у 70% всех заболевших. У таких больных обнаруживается высокая сенсибилизация (чувствительность) к различным инфекционным агентам – кишечной палочке, стафилококку и пр. Во время рецидива экссудативной эритемы у больных отмечается снижение устойчивости организма, понижение Т-клеточного иммунитета. Таким образом, основной причиной развития данной формы многоформной эритемы является развитие иммунодефицитного состояния, которое, в свою очередь, провоцируется: хронической инфекцией; переохлаждением; заражением вирусной инфекцией; гелио-магнитными воздействиями. Причиной появления токсико-аллергической разновидности экссудативной эритемы является прием лекарственных средств. Чаще всего, подобная реакция организма наблюдается на прием барбитуратов, препаратов тетрациклинового ряда, сульфаниламидов.<br /><br /></p>",
"pathogenesis": "",
"diagnostics": "<p align=\"justify\">Для диагностики заболевания на консультации дерматолога проводится тщательный осмотр высыпаний и дерматоскопия. При сборе анамнеза уделяется внимание связи с инфекционным процессом или введением лекарственных препаратов. Для подтверждения диагноза многоформной экссудативной экземы и исключения других заболеваний с поверхности пораженных участков кожи и слизистой берут мазки-отпечатки.</p>\r\n<p align=\"justify\">Многоформную экссудативную эритему дифференцируют с пузырчаткой, диссеминированной формой СКВ, узловатой эритемой. Быстрая динамика сыпи, отрицательный симптом Никольского и отсутствие акантолиза в мазках-отпечатках позволяют дифференцировать многоформную экссудативную эритему от пузырчатки.</p>\r\n<p align=\"justify\">При фиксированных формах многоформной экссудативной эритемы необходимо проводить дифференциальную диагностику с сифилитическими папулами. Отсутствие бледных трепонем при исследовании в темном поле, отрицательные реакции ПЦР, РИФ и RРR позволяют исключить сифилис.</p>",
"treatment": "<p align=\"justify\">ечение в остром периоде зависит от клинических проявлений многоформной экссудативной эритемы. При частом рецидивировании, поражении слизистых, диссеминированных высыпаниях на коже, появлении некротических участков в центре элементов сыпи пациенту показано однократное введение 2 мл дипроспана.</p>\r\n<p align=\"justify\">При токсико-аллергической форме первоочередной задачей лечения является определение и выведение из организма вещества, спровоцировавшего возникновение многоформной экссудативной эритемы. Для этого пациенту назначается обильное питье, энтеросорбенты, мочегонные средства. При впервые возникшем случае заболевания или при наличие в анамнезе данных о самостоятельном быстром разрешении его рецидивов введение дипроспана, как правило, не требуется.</p>\r\n<p align=\"justify\">При любой форме многоформной экссудативной эритемы показана дессенсибилизирующая терапия: супрастин, тавегил, тиосульфат натрия и др. Антибиотики применяют только в случае вторичного инфицирования высыпаний.</p>\r\n<p align=\"justify\">Местное лечение многоформной экссудативной эритемы заключается в применении аппликаций из антибиотиков с протеолитическими ферментами, смазывании пораженных участков кожи антисептиками (р-р хлоргексидина или фурацилина) и кортикостероидными мазями, в состав которых входят антибактериальные препараты (триоксазин, дермазолин). При поражении слизистой полости рта назначают полоскание отваром ромашки, ротоканом, смазывание облепиховым маслом.</p>\r\n<p align=\"justify\">Профилактика рецидивов многоформной экссудативной эритемы при инфекционно-аллергической форме тесно связана с выявлением и устранением хронических инфекционных очагов и герпетической инфекции. Для этого пациенту может потребоваться консультация отоларинголога, стоматолога, уролога и других специалистов. При токсико-аллергическом варианте многоформной экссудативной эритеме важно не допускать приема провоцирующего заболевание медикамента.</p>",
"prevention": "<p>Профилактика многоформной эритемы заключается в своевременной санации очагов инфекции, а также, в исключении применения лекарств и особенно антибиотиков без назначения врача.<br /><br /></p>",
"clinical_picture": "<p>Симптомы и проявления эритемы зависят от формы заболевания.</p>\r\n<p>Инфекционно-аллергическая разновидность эритемы может начинаться как грипп. При инфекционно-аллергической разновидности эритемы заболевание, как правило, начинается остро. Первые симптомы могут несколько напоминать грипп, больные экссудативной эритемой начинают ощущать <a href=\"/symptom/utomlyaemost/\" title=\"Перейти на страницу симптома Утомляемость\">недомогание</a>, часто отмечаются боли в мышцах, суставах, першение в горле. Через сутки после начала заболевания появляется <a href=\"/symptom/syp/\" title=\"Перейти на страницу симптома Сыпь\">сыпь</a>, которая является характерным симптомом экссудативной эритемы. <a href=\"/symptom/syp/\" title=\"Перейти на страницу симптома Сыпь\">Сыпь</a> появляется на коже и слизистой рта, реже поражаются слизистые половых органов. Слизистые при многоформной эритеме поражаются примерно у третьей части заболевших. Изолированное поражение оболочек рта (без высыпаний на коже) отмечается только у 5% заболевших. Как правило, через несколько суток после появления кожного синдрома общие симптомы проходят, однако, невысокая температура может держаться несколько недель. Для экссудативной эритемы характерно появление на коже пятен или плоских папул, цвет высыпаний ярко-розовый или красный. Пятна быстро увеличиваются в размерах, их центральная часть западает и приобретает синюшный цвет, в то время как периферические края охраняют красную окраску. В некоторых случаях, в центральной части пятен могут появиться пузыри с прозрачным или кровянистым содержимым. Реже отмечается появление пузырей на неизмененной коже. Кожа стоп — это одно из мест локализации многоформной экссудативной эритемы. <a href=\"/symptom/syp/\" title=\"Перейти на страницу симптома Сыпь\">Высыпания</a> при экссудативной эритеме локализуются на коже стоп, кистей, голеней, предплечий. При поражении и слизистой рта экссудативная <a href=\"/symptom/pokrasnenie_kozhi/\" title=\"Перейти на страницу симптома Покраснение кожи\">эритема</a> имеет более тяжелое течение. <a href=\"/symptom/syp/\" title=\"Перейти на страницу симптома Сыпь\">Высыпания</a> в этом случае локализуются на губах, небе, щеках. Сначала на слизистых образуется отек, потом появляются пузыри. Вскоре они вскрываются с образованием крайне болезненных эрозий, которые склоны к слиянию в обширную раневую поверхность. <a href=\"/symptom/izmeneniya_struktury_kozhi/\" title=\"Перейти на страницу симптома Изменения структуры кожи\">Эрозии</a> могут покрываться сероватым налетом, при снятии которого поверхность слизистой начинает кровоточить. Поверхность эрозий покрываются кровянистыми корками разной толщины, а в случае вторичного инфицирования пораженной слизистой корки приобретают серый цвет. У некоторых больных экссудативной эритемой поражение охватывает всю слизистую рта, у других – появляются единичные элементы высыпаний. При значительной площади поражения площади рта возникает сильный болевой синдром. Больные многоформной эритемой не могут нормально открыть рот, это обстоятельство делает невозможной речь и прием пищи. Наличие кариеса, пародонтоза способствует усугублению процесса. При многоформной эритеме <a href=\"/symptom/syp/\" title=\"Перейти на страницу симптома Сыпь\">высыпания</a>, появившиеся на коже, разрешаются через 2 — 3 недели. <a href=\"/symptom/syp/\" title=\"Перейти на страницу симптома Сыпь\">Высыпания</a> на слизистых не заживают по 4 — 6 недель. В большинстве случаев, многоформная <a href=\"/symptom/pokrasnenie_kozhi/\" title=\"Перейти на страницу симптома Покраснение кожи\">эритема</a> имеет рецидивирующее течение, обострения чаще случаются в периоды межсезонья. Редко отмечаются тяжелые случаи, при которых рецидивы заболевания следуют один за другим. Симптомы токсико-аллергической эритемы мало отличатся от описанных выше. При этой форме <a href=\"/symptom/syp/\" title=\"Перейти на страницу симптома Сыпь\">высыпания</a> могут носить распространенный характер или быть фиксированными. В первом случае, практически у всех заболевших отмечается поражение слизистой рта.<br /><br /></p>",
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