Toxidermy: symptoms and treatment
Toxidermy, which is also defined as a toxic-allergic dermatitis, is an acute inflammatory process that focuses, like any kind of dermatitis, within the skin, and in this variant, mucous membranes can also be affected. Toxidermy, the symptoms of which are manifested as a result of a lesion produced by the respiratory tract, the digestive canal, or the introduction of a stimulus through the muscle, skin or vein, mainly implies a drug form of the disease.
Considering the fact that the toxemia, as we noted above, mainly develops in the form of a drug, that is, as a side effect, formed against the background of taking certain medications, this variant, being the most common in the manifestation, is considered among the reasons for it Occurrence as the main one.
In this, medicinal variant, the ingestion of an allergen occurs in one of the above ways, which leads to its entry into the compound produced with the cytoplasm (more precisely, its functional structures), which is subsequently ensured, in turn, by its entry into the blood. Organs and blood can be affected, in addition, also when suppressing enzyme systems with a drug, toxic damage to blood vessels and tissues (which is especially important when considering an overdose situation), general changes in the reactivity of the body.
Toxidermia can manifest itself in two forms, being fixed or common. Below we consider the features of both options.
Clinic manifestations of the dosage form of the toxicum is characterized by eruptions of papular, erythematous, papular-vesicular or vesicular type. Often, a common vesicular or papular rash is diagnosed, which is concentrated within the skin and mucous membranes, and erythematous diffuse foci or erythroderma are developed less frequently. It is noteworthy that in each patient individually the same medicinal substance used can provoke a different for the part of morphological signs of a toxidermy.
The inflammatory process, which is topical in case of toxemia, in the area of the mucous lips and mouth, can appear in several variants of the lesion, being hemorrhagic, catarrhal or vesicourous-erosive. The localization of lesions of the mucosa focuses not only in the area of the lips, gums and tongue, but also can affect the oral mucosa (in particular, it is a defeated spillage).
It is also important to note that some varieties of medications manifest themselves in the form of only a characteristic picture of the disease. For example, the bromide or iodine toxidermy caused by the use of iodine bromide or salts or the use of alcoholic iodine is manifested in the form of acne (it is defined as «iodine acne», «bromide acne») or in the form of tuberous Bromoderma (iododerma) — it, in turn, manifests itself in the form of soft and juicy plaques, somewhat towering above the level of the skin. Plaques in the latter case are covered with purulent crusts, after removal of which there is an exposure of the surface of the infiltrate, which, in turn, is separated by pus.
For this condition, the appearance of epithelium and epidermis is characteristic, that is, a process that resembles a pronounced skin burn in combination with the oral mucosa and corresponding to its 2nd degree. Necrolysis is otherwise defined as a syndrome of scalded skin, as a whole this process involves deadening and decomposition, the epidermis decomposes, subsequently peeling off the dermis. Some patients in this process face previous erythema and skin tenderness, which is strong enough in its manifestation.
Predominantly the process is characterized by its own prevalence. It is accompanied by the appearance of unstressed blisters on the mucous membranes and on the skin, these bubbles can manifest themselves in different sizes, because of their characteristic structural features they are opened quickly, then replaced by bright red scale erosions, gradually increasing in their distribution. Even a slight touch to the skin, apparently not changed, leads to easy rejection of the epidermis, which practically slips from the underlying tissues, hanging with large patches.
A similar type of change is also formed on the oral mucosa, without the exception of the conjunctiva in such a process and other mucous membranes. As a result, the condition of patients is determined solely as severe. In parallel, the process is accompanied by fever in combination with severe toxicosis, the condition is often comatose in patients, ESR in the blood increases, cardiac activity is impaired.
Fixed Toxicermia: Symptoms
This form of toxemia is characterized by the formation of oval or round erythematous spots of the order of 2-3 cm in diameter, which, after about a few days, acquire a brownish tinge, and in some such spots, at the very center, a bubble appears. In the event that you stop taking the «problem» drug, the resolution of the process takes place within the next 7-10 days.
If the drug is taken repeatedly, this, in turn, will lead to a recurrence of the process, and almost inevitably — in the same place as before, although it is not excluded the possibility of its appearance in other areas. It is noteworthy that the majority of patients are faced with a variant in which rashes in a simultaneous order are formed not only on the oral mucosa, but also in the area of the external genitalia, anus and skin.
In some variants of the course, fixed toxemia with its medicinal etiology develops on the mucosa of the mouth, but without visible inflammation, accompanied only by the manifestation in the form of intense blisters. Establishment of the correct diagnosis is possible on the basis of establishing an appropriate connection with the nature of the occurrence of rashes and with the use of specific medications in particular (mainly they include salicylates, barbiturates, tetracycline, etc.).
When there is toxicum against the background of the use of sulfanilamide drugs, a fixed erythema is often formed, which is concentrated in the same area after about several hours from the time of the use of the drug on the basis of this component. After the disappearance of erythema (which occurs within a few days) at the site of its development remains pigmentation of an aspidum-brown hue, the intensification of which is noted with each new relapse of the disease.
On the part of symptoms of a general scale, the appearance of disorders associated with the activity of the central nervous system, which manifests itself in irritability, in some cases changing depressive states, emotional imbalance, insomnia, etc., may appear. Also, fever may be noted in combination with weakness and general malaise, symptomatology corresponding to manifestations of cardiovascular and small vessel damage, symptomatology of kidney and liver damage against a background of drug disease is not ruled out. Symptomatics of a subjective scale is reduced mainly to burning and skin itching, to soreness of the skin and to its general tension in the area of lesions.
Common Toxicermia: Symptoms
This form of toxemia is a rather serious disease, the course of which is accompanied by a combination of not only the symptoms associated with mucocutaneous manifestations in the affected areas, but also implies a combination with the processes in which various organs and systems of the organism are affected, that In some cases can lead to quite serious consequences. Thus, the manifestations of such lesions are often reduced to an increase in temperature, to chills and dyspeptic phenomena (ie digestive disorders), and even to coma.
The course of this form of the disease is also short in the case of the timely withdrawal of the medication acting as an allergen.
This form of dermatitis can proceed in a similar way to diseases such as urticaria, lupus erythematosus, flat red lichen, pink zhibera, multi-form exudative erythema, etc.
As epidermal necrolysis in acute form — Lyell’s syndrome is considered as one of the most severe forms of toxicermia (mainly the medicinal nature of the onset) as a response to infectious or other types of toxic agents. It is characterized by the process of necrolysis of the epithelium and epidermis, which have certain similarities with the clinic of skin burns and oral mucosa, corresponding to the second degree. Some patients in this case face previous erythema in combination with pronounced soreness of the skin.
Iododerma, bromoderm: symptoms
In relatively rare and at the same time complex in the diagnosis are such manifestations of toxicodermia as iododerm and brododerm, whose appearance is advisable to be considered when a characteristic symptomatology emerged against the background of the use of iodine-containing drugs and preparations of bromine-containing.
Bradoderma in particular is characterized by the appearance of rashes of a very different type of manifestation, that is, it can be eruptions of erythematous or papule-pustular, urtic or bullous, acne-like (acneiform) or warty.
The most frequent form of the appearance of rashes is brominated acne, which is formed as a follicular type of pustules, and the size of these pustules can fluctuate within the framework of the head of the pin and up to the size of the lentil. Characteristic nodular elements have a pinkish-violet hue, the concentration of which is noted on the face, limbs and back. The healing of these can later leave scarring of small size and a brownish-violet hue on the surface areas of skin of the surface type that were previously damaged.
The data on the form of toxidermia manifestation, as it is possible, are characterized by the intrinsic features of the flow, which we will consider below.
- Tuberous bromoderm (the form is vegetative). Primarily formed in women of the young age category. In the case of a rash in this case, the appearance of tumor-like and knotty plaques, few in its manifestation and limited in size. The color is violet-red, the elevation above the level of the skin is about 0.5-1.0 cm. Nodes in size can appear both within a pea and in sizes comparable to a pigeon egg. Such nodes are covered with dense purulent-bloody crusts, whose removal subsequently determines the presence of a tuberous ulcerous surface, along which, in turn, sprouting of the warty-papillary type can form. Squeezing the foci with lesions leads to the appearance of copious pus on the surface. A similar «tumor formation» resembles a soft sponge soaked in pus. What is noteworthy, in this variant of the manifestation of toxemia, the lesion of visible mucous membranes occurs extremely rarely. In general, the disease is characterized by the well-being of its own course, its completion is marked by residual phenomena in the form of pigmentation and atrophic scars.
- Iododerm. Most often it manifests itself in tuberous and bullous form. The course of the tuberous form is often characterized by a complication in the form of vegetation (elements of a rash of secondary manifestation manifesting in the form of growth of the dermis, more precisely, its papillary layer, and also of the epidermis in the form of uneven papillomatous formations). With regard to iododerma bullosa, the onset of rashes with it is characterized by the appearance of bubbles in diameter up to 5 cm, strained and with hemorrhagic fluid inside. The opening of such bubbles leads to the exposure of the bottom, on which, in turn, there are significant vegetation in their manifestations.
- Iododerma (tuberous) The onset of its manifestation is marked by the formation of a nodule that gradually transforms into a pustule, and then into a formation resembling a tumor, its size can reach 5 cm. The edges of the foci of inflammation are somewhat elevated above it, in the mammals there are small vesicles with characteristic serous-purulent contents in them. In terms of consistency, the focus is on pastovy (swollen), pressure on the surface leads to the release of pus, in which an admixture of blood can be seen. Basically, the localization of iododerm is noted in the face area, the trunk or extremities are less often affected by this lesion.
On the whole, the clinic of manifestations of the considered states determines a significant similarity with each other, which is explained by the identical mechanism of development of the actual for them formations due to the use of drugs corresponding to a particular chemical group.
The treatment of toxicdermia, as can be supposed, is primarily aimed at blocking the substance that provoked the processes that are relevant for the given state, which implies in parallel the taking of measures for the rapid withdrawal of this substance from the body. Accordingly, the internal use prescribed antihistamines, desensitizing drugs, as well as laxatives and diuretics.
As for the local effects, that is, the impact on the rash, then there are already used antipruritious chatterboxes, ointments (corticosteroids), and also a cream of cooling effect.
Extensive defeat requires the implementation of such an external treatment, which is usually used in case of burns. In addition, it is prescribed purified / liquid food, saturated with proteins, drinking (abundantly), vitamins (ideally — in the form of mixtures, which include, for example, cottage cheese, protein, cream).
In case of damage to the oral mucosa, anesthetics, disinfectants and astringents are prescribed for use. With difficulty swallowing, special nutritional enemas are used. If necessary, rinsing of the eyes with boric acid, hydrocortisone ointment, zinc drops is used.
To diagnose a disease, you need to contact a dermatologist, it may be that you need an allergist consultation.