Toxidermia

Description:

Toxidermia, or toksiko-allergic dermatitis - an acute inflammation of integuments, and sometimes and mucous membranes, developing under the influence of an irritant through respiratory tracts, the digestive channel, at introduction to a vein, under skin or in a muscle. In most cases it is about a medicinal toxidermia.

There are two types of a toxidermia - fixed and extended.

Toxidermia symptoms:

The clinical picture of a medicinal toxidermia is characterized by erythematic, papular, vesicular or papulo-vesicular rashes. Widespread papular or vesicular (violent) rash on skin and mucous membranes is often noted, there are diffusion erythematic centers or erythroses less often. The same medicinal substance can cause morphologically different form of a toxidermia in various people. On a mucous membrane of a mouth and lips process can be shown in the form of catarral, hemorrhagic, vesical and erosive defeat. Rashes are localized not only on gingivas, language, lips, and sometimes have character of diffuse damage of a mucous membrane of a mouth.

At the same time some medicines cause a clinical picture of a toxidermia, characteristic of them. So, development of acne rash ("bromic" or "iodide eels") or a tuberous bromoderma (yododerm) which is shown by the juicy, soft, towering over skin level plaques covered with purulent crusts is characteristic of an iodide or bromic toxidermia (arises at reception of salts of iodine or bromine, and also spirit solution of iodine). After removal of crusts the vegetans surface of infiltrate separating pus is bared.

The fixed toxidermia is characterized by emergence of one or several round or oval, with a diameter up to 2-3 cm, erythematic spots which later accept several days a brownish shade. In the center of some spots the bubble forms.

If administration of drug is stopped, then within 7-10 days process is allowed. At repeated reception of the same drug process recurs surely on the same place, but can arise also on other sites. At most of patients of a rash at the same time appear not only on a mucous membrane of a mouth, but also on external genitals, in the field of an anus and on skin.

Sometimes the fixed toxidermia of a medicinal etiology proceeds on a mucous membrane of a mouth without visible inflammatory reaction and is characterized by emergence only of intense bubbles. Help to make the correct diagnosis establishment of existence of communication of developing of rashes with reception of medicines (more often than streptocides, tetracycline, barbiturates, salicylates, etc.), absence in smears prints of akantolitichesky cells, etc.

The toxidermia caused by sulfanamide drugs often is shown in the form of the fixed erythema which arises on the same place in several hours after reception of any sulfanamide drug and leaves after the disappearance (in several days) flaky-brown color the pigmentation amplifying after each new recurrence.

From the general symptoms functional disturbances from a nervous system (the irritability which is replaced by a depression, sleeplessness, emotional lability, etc.) can be observed, the temperature increase accompanied with a febricula, weakness, passing arthralgias, symptoms of defeat of cardiovascular system including small vessels (that causes development of a hemorrhagic component), and also a liver and nights (drug disease). Subjective symptoms in most cases come down to feeling of an itch, burning, tension and a dermatalgia of affected areas.

Widespread toxidermia - a serious illness at which the skin and mucous symptomatology is combined with defeat of other bodies and systems, sometimes quite serious (fervescence, oznoba, the dispepsichesky phenomena, an adynamia, coma, etc.).

Current of a medicinal toxidermia on condition of timely cancellation of medicine allergen usually short.

The widespread toxidermia can proceed under, a type of such diseases as a small tortoiseshell, red flat deprive, a mnogoformny exudative erythema, an allergic vasculitis (purpura), a lupus erythematosus and pink deprive of Zhiber.

One of the heaviest forms of a toxidermia, is more often than a medicinal etiology, is more rare in response to others toxic, and also infectious agents, the acute epidermal necrolysis - a Lyell's disease is. The necrolysis of epidermis and an epithelium reminding a clinical picture at a burn of skin and mucous membrane of a mouth of the II degree is characteristic of it. At some patients this process is preceded by an erythema, and also a sharp dermatalgia. Nikolsky's symptom sharply positive. More often process has widespread character. The mixed not intense bubbles arising on skin and mucous membranes are quickly opened, on their place the merging becoming wet bright red erosion which area quickly enough increases are formed. Even at easy touch to externally not changed skin epidermis easily is torn away, as if slides off the subject fabric and hangs down in extensive rags. Similar changes arise on a mucous membrane of a mouth, lips, a conjunctiva and other mucous membranes. General condition of patients heavy. Process is followed by high temperature of a body, the expressed toxicosis, is frequent coma, disturbance of cordial activity, an albuminuria, increase in SOE. Quite often at a Lyell's disease patients perish. It is necessary to differentiate with exfoliative dermatitis, toxicosis of pregnant women, an acute pemphigus, a severe form of an exudative polymorphic erythema - Stephens-Johnson's syndrome.

Differential and diagnostic value has existence of symptoms of damage of internals, a nervous system of vessels at a medicinal toxidermia. The etiological role of medicines with reliability can be confirmed by means of an allergological research (method of skin tests, reaction of agglomeration of leukocytes on Fleka, degranulation of basophiles according to Shelley, etc.). At suspicion in some cases it is possible to appoint to a sulfanamide erythema in a dormant period in 0,15-0,3 g of the same sulfanamide drug which the patient most often accepted (a provocation method). If drug is chosen correctly, then there is a process aggravation. The same test is made with antipyrine and barbiturates.

Toxidermia reasons:

The reasons of a toxidermia are various, but more often they develop as result of side effect of medicines.

The medicinal toxidermia serves as manifestation of the sensibilizing action of a medicine. In its pathogeny allergic and toxic components are often combined in various ratios, causing development of diverse damages of skin, mucous membranes, nervous and vascular systems, internals inherent to a drug disease. The medicinal toxidermia can arise as result of long introduction of a medicine. At some patients the toxidermia develops as manifestation of paraallergic reaction. In such cases the intolerance is prepared for medicinal substances by the previous diseases (rheumatism, quinsy, an epidermophitia, etc.). At some patients the medicamentous toxidermia develops as a result of an idiosyncrasy to medicinal substances. The expressed allergic properties, except the medicines specified in the section on allergic dermatitis also chlortetracyclin (biomycin), chloramphenicol, drugs of organic arsenic (Novarsenolum) and iodine, vaccines and serums, B1, B6, V12 vitamins, aminazine, antipyrine, AKTG, angiotrophine, chloroquine, Chingaminum, etc. possess. Antibiotics, sulfanamide drugs, compounds of quinine have especially expressed allergic properties.

Allergen, getting in cells of skin and other fabrics, enters connection with functional structures of cytoplasm (nucleoproteids, mitochondrions), and then leaves in a blood plasma. Damage of skin and other bodies can also result from suppression by medicine of fermental systems, toxic damage of fabrics, vessels (especially at overdose) and change of reactivity of an organism.

Among the reasons of a toxidermia feedstuffs are on the second place, at the same time the disease arises as result of a sensitization to separate products, or owing to the use of the spoiled products causing toxic action.

For clarification of an etiology of a toxidermia use peroral diagnostic tests, reaction of regional transformation of lymphocytes, reaction of degranulation of basophiles according to Shelley. At the same time it must be kept in mind that one and same reason can cause various manifestations in different people.

Treatment of the Toxidermia:

In mild cases recovery happens in several days. For acceleration of recovery appoint antihistaminic drugs and glucocorticoids. Apply an artificial diuresis and an enterosorbtion to acceleration of removal of a causative factor from an organism.