Многоформная экссудативная эритема (МЭЭ) -острое рецидивирующее заболевание кожи и слизистых оболочек, связанное с реакцией гиперчувствительности на применение лекарственного препарата, инфекцию, злокачественные новообразования, вакцинацию или заболевания аутоиммунной природы. Точная частота возникновения многоформной экссудативной эритемы неизвестна. Этиологические особенности и клинические проявления данного заболевания разнообразны. Несмотря на разнообразие причин развития МЭЭ, инфекционные заболевания составляют около 90% случаев, наиболее распространенным возбудителем является вирус простого герпеса. Самые ранние проявления МЭЭ обычно представляют собой круглые, эритематозные, отечные папулы, окруженные участками просветления, которые могут напоминать укусы насекомых или папулезную крапивницу. Затем на месте папул образуются хорошо известные мишеневидные очаги. Очаг-мишень состоит из части эпидермального некроза, расположенного по центру, который может выглядеть как темная область или волдырь. Основой постановки диагноза многоформной экссудативной эритемы являются анамнез заболевания и объективный клинический осмотр. В большинстве случаев МЭЭ не требует дополнительных методов исследования. Знание этиологических факторов и клинических проявлений данной патологии позволяет своевременно диагностировать заболевание и начать лечение для предупреждения развития серьезных осложнений. Ключевые слова: многоформная экссудативная эритема, синдром Стивенса-Джонсона, очаг-мишень, вирус простого герпеса.
Обзор литературыХисматуллина Зарема Ри- мовна -д.м.н., профессор, кафедра дерматовенерологии с курсами дерматовенерологии и косметологии ИДПО, orcid.org/0000-0001-8674-2803 Л ипова Елена Валерьевна -д.м.н., профессор, кафедра дерматовенерологии и косметологии с курсом клинической лабораторной диагностики, orcid.org/0000-0001-6490-9529 Хамматова Алсу Анваровна -дерматологическое отделение № 1, orcid. org/0000-0003-4556-1867 Хаб ибуллина Миляуша Ильмировна -кафедра дерматовенерологии с курсами дерматовенерологии и косметологии ИДПО, orcid. org/0000-0001-9650-3400 Наджафизаде Элахе -кафедра дерматовенерологии с курсами дерматовенерологии и косметологии ИДПО, orcid.org/0000-0003-3457-5673
The purpose of the study is to evaluation of peculiarities of complaints, symptoms and clinical manifestations of typical asymptomatic (L43.80) and erosive-ulcerative (L43.82) forms of lichen planus (LP), its manifestations on the oral mucosa, depending on the age and sex of patients. Material and methods. In the present study, 111 patients with OLP were divided into a main clinical group with erosive-ulcerative form of OLP (L43.82, n = 86) and a comparison group with typical asymptomatic form of OLP (L43.80, n = 25) based on the complex of dental examination and simple randomization method. Mann–Whitney and chi-square tests, including Yates' correction, were used to assess the statistical significance of differences between the groups. Results. Patients with the typical asymptomatic form of OLP (L43.80) often had grayish-white, flat papules up to 2 mm in diameter on the unchanged mucosa of the cheeks and dorsal surface of the tongue in the absence of complaints. In the erosive and ulcerative form (L43.82) of OLP, the complaints of pain, intensifying at intake of hard, spicy and hot food, feeling of tightness, roughness, burning, slight dryness prevailed, papules, erosions of irregular or polygonal ulcers were simultaneously observed on swollen, hyperemic mucosa of cheeks, corners of mouth and lateral surface of tongue. The studied pathology prevailed in 81.98% of cases in persons of young working age. Depending on the form of OLP, the intensity of caries according to the CPU index corresponds to a high or very high degree of caries process, the state of oral hygiene according to the OHI-S index of poor or poor hygiene, the inflammatory process in periodontal tissues according to the PMA index of mild or medium degree of inflammation (p < 0.001). Conclusion: thus, the identified features of complaints, symptoms and manifestations of oral mucosal lichen planus should be taken into account by general practitioners when conducting outpatient appointments.
Relevance. Lichen planus is a chronic disease affecting the skin and oral mucosa. There is no exact data on the prevalence of lichen planus, which is due to the late appeal of patients not only to dentists, but also to dermatologists. The aim of this study was to learn some of the features of the clinical manifestations of typical, exudative-hyperemic, erosive-ulcerative and bullous forms of lichen planus on the oral mucosa. Material and methods. In the present study, on the basis of screening examination of patients who applied for dental care in dental clinics and living in the cities of Ufa, Omsk, Nizhny Novgorod, Nahariya, Kazan, we studied some of the clinical features of various forms of lichen planus of the oral mucosa, and the peculiarities of their course. In the course of a comprehensive dental examination, all examined persons were divided into four study groups: 1 clinical group (39.5%) — patients with a typical form, 2 clinical group (25.6%) — patients with exudative-hyperemic form, 3 clinical group (6.9%) — patients with a bullous form, 4 clinical group (27.9%) — with an erosive and ulcerative form of lichen planus. Results. In the course of a comprehensive dental examination, in 39.5% of cases, a typical form of lichen planus was revealed, in 61.3% of cases it was bullous, exudative-hyperemic and erosive-ulcerative forms, with their prevalence in 70.9% of cases in females. The average age of patients diagnosed with a typical form of lichen planus was on average 42.5±3.5 years, exudative-hyperemic form — 48.2±3.8 years, bullous — 49.8±3.6, erosive ulcerative form — 50.6±3.2 years. The duration of development of all studied forms of lichen planus was on average from 4 months to 5 years (the development of the typical form was 1.4±0.4 years, exudative-hyperemic — 2.1±0.8 years, bullous form — 3.9±1.2, and the erosive and ulcerative form — 4.3±1.2 years.
Subject. The results of a comprehensive microbiological study of the state of the normobioma of the oral cavity in individuals with recurrent aphthae of the oral cavity against the background of acid-dependent diseases of the gastrointestinal tract are considered. The goal is to determine the diagnostic significance of individual representatives of the oral normobioma in patients with recurrent aphthae of the oral cavity against the background of acid-dependent diseases of the gastrointestinal tract. Methodology. The study involved 83 patients who were divided into two main and control groups depending on the clinical manifestations of recurrent aphthae of the oral cavity on the background of hypersecretory syndrome. Results. The results of the study showed that in patients of the first and second main groups, in which the manifestations of recurrent aphthae in the oral cavity were accompanied by diseases of the gastrointestinal tract with hypersecretory syndrome, the frequency of allocation of staphylococcal flora was 1.3—1.5 times higher compared to control (p≤0.05), an increase in the proportion of S. aureus — 2.5 times. The detection frequency of S. epidermidis in the control and both clinical groups was 28.0, 27.6 and 31.0 % of cases, respectively, the proportion of hemolytic forms in the control group was 4.0 %, in the first 10.3 % (an increase of 2 5 times), in the second — 17.2 % (4.3 times). The observed changes in the species composition may indicate dysbiosis in the oral cavity, caused not only by the presence of recurrent aphthae, but also by acid-dependent diseases of the gastrointestinal tract. Conclusions. In recurrent aphthae of the oral cavity in patients with acid-dependent diseases of the gastrointestinal tract in the microbiome of the oral cavity against the background of reduced titers of lactobacilli, an increase in representatives of Staphylococcus spp., Enterococcus spp is most often observed. and Candida spp. (1.2 times average), Enterococcus spp. (1.4 times), Staphylococcus spp. and Enterobacteriaceae spp. (1.2 times), Actinobacillus spp. (1.1 times).
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