Toxicoderma (toxidermia): symptoms, treatment, photo

Toxicoderma (sometimes the terms toxidermia, toxico-allergic dermatitis are used) refers to acute inflammatory disease of the skin and mucous membranes, which has toxic or mixed character.

The most often provocateurs of toxicoderma are medications, a little less often food and related factors. Almost any drug or substance can cause the development of an inadequate reaction of the body, therefore, the first signs of the disease should be treated very carefully.

Causes of toxicoderma

As a rule, the toxic mechanism of action resembles any allergic reaction, but the symptoms of the disease are dangerous in their complications.

1. The most common cause of this form of toxicoderma is medication. In this case, drug toxicoderma occurs in 5% –60% of all diseases. Toxicoderma provocateurs can be antibiotics, antispasmodics, narcotic substances, pain relievers, etc. The dosage form of toxicoderma can be caused by any pharmaceutical groups, including antihistamines drugs.

1. The second most common among toxicoderma is food allergy. In this case, fish, honey, strawberries, citrus fruits, eggs and other foods with high allergenicity can be allergens. Toxicoderma is possible when various additives and emulsifiers and dyes enter the digestive tract, which are often added to food.
2. In addition, in some types of professional activity, contact with various chemicals that can lead to acute toxidermia is possible.
3. Sometimes there are cases of toxicoderma disease as a result of rejection by the patient's immune system of dentures and metal structures used in dental practice.

Toxicoderma, as a rule, involves the ingress of toxic substances into the body through the respiratory and digestive systems, however, in the event that there is a negative reaction to medications, the danger can be any way they introduction.

Types of toxicoderma

To date, there is an increase in the incidence of toxicoderma and, although the etiology and causes of toxicoderma are not fully understood, there are several main types of the disease.

1. Medicinal (medicinal) toxidermia

Medicinal toxidermia is most often caused by the following drugs:

• antibiotics, barbiturates, sulfonamides;
• antihistamines, corticosteroids, vitamins of groups PP, B, C;
• novocaine, rivanol, furacilin.

The route of administration of drugs (oral, intravenous, inhalation, intramuscular, or in an enema) with toxicoderma is of no small importance. The most dangerous is inhalation and percussion drug toxidermia, and the most favorable is considered to be intravenous administration of the drug. The disease proceeds with complications when the patient has chronic diseases that require additional medication.

Most often, the fairer sex falls ill, which is explained by the possibility of cross-sensitization as a result of the more active use of decorative cosmetics. In addition, they are much more likely to come into direct contact with household chemicals for daily cleaning.

As a rule, there is a monovalent (per drug) sensitization to a drug, but sometimes cross-allergy to drugs of one (several) groups is possible. It should be noted that drug toxidermia can occur on any drugs, except saline and glucose.

2. Professional

The most pronounced signs of this type of toxicoderma include a strong reaction to the slightest effect of an irritant. In terms of the severity of the reaction, widespread professional toxicoderma does not correspond to the strength of the action. Industrial allergens are most often nickel, cobalt and chromium, which are activated under the influence of harmful factors.

As a rule, at this stage of the disease, after the cessation of the action of the stimulus, the inflammatory process disappears as quickly as possible, but at the slightest contact with an irritant, rapid relapses.

It is important to note that the inflammatory process is impossible without an irritant!

It is characteristic that occupational toxicoderma is in the middle between the development of occupational eczema and occupational dermatitis. In the absence of exacerbations in response to a stimulus, these forms may have similar symptoms.

In the acute stage of the disease, common erythema, edema, bullous and vesicular rashes are observed. As a rule, non-hormonal therapy is used with this form.

3. Food toxicoderma

A common type of disease, since a person can take more than 120 types of various allergens with food. Most often, an allergic reaction occurs to proteins that come with food. There are a lot of proteins in meat, fish, eggs, strawberries, citrus fruits, etc.

Often, medical history reveals immunological rejection of various colors and flavors added to food.

4. Autointoxication

Toxic-allergic dermatitis of an autointoxication type develops with gastritis, ulcers, pancreatitis, hepatitis and diseases kidney (pyelonephritis, hydronephrosis), as well as malignant neoplasms (renal adenocarcinoma, intestinal cancers and lungs).

Autotoxic toxicoderma is capable of degeneration into a chronic process, which complicates the treatment process.

Classification of toxicoderma by severity

Complicated dermatitis, as well as toxicoderma, can be accompanied by various complications in which the liver, lungs, brain and spinal cord are affected. The most dangerous complications include cerebral edema.

• A mild degree of toxicoderma - accompanied by slight itching of the affected areas of the skin and rashes in the form of urticaria (photo below), erythematous spots and nodules. In this case, the general condition of the patient deteriorates slightly. For treatment, non-hormonal therapy is used. After a short time, the symptoms of the disease disappear;

• toxicoderma of moderate severity - there is severe itching, accompanied by hyperthermia, urticaria, erythema, the appearance of vesicles and single blisters. When performing a laboratory examination, a violation of the clinical picture is noted;
• severe stage of the disease - there is a sharp rise in body temperature. Intoxication increases and may be accompanied by vomiting. The appearance of a rash of the type of giant urticaria (Quincke's edema) is noted, in severe cases of toxicoderma, anaphylactic shock and cerebral edema are possible. There may be erythroderma, Lyell's syndrome (bullous form of the disease), eosinophilia.

The inflammatory process can spread to internal organs and systems.

Diagnostics

Differential diagnosis is based on the clinical picture.

First of all, anamnesis is collected to find out the cause of the disease and a visual examination the patient, since with toxicoderma, the analysis for the detection of an allergen is very often not able to give 100% result.

If necessary, biopsy and histological examination of the source material can be performed. It should be borne in mind that a biopsy in the gastrointestinal tract may be accompanied by increased sensitivity. A biopsy of the skin covered with a rash reveals lymphocytic and eosinophilic infiltration.

To exclude the infectious-bacterial nature of toxidermia, it is recommended to diagnose bacterial inoculation of scrapings from the affected area of ​​the skin. With severe development of the disease, it is possible to conduct a coagulogram, blood and urine tests.

Development of toxicoderma in children

Toxic-allergic dermatitis among children belongs to allergic diseases, therefore, the treatment of toxidermia is a priority aimed at eliminating the negative effects of allergens and taking antihistamines (Tavegil, Loratadin, Suprastin etc.). The factors for the development of the disease in children are similar to allergic contact dermatitis.

In young children, fixed toxidermia is most often observed as a result of the food pathway for the development of allergies (pictured below), but if therapeutic treatment is used in a timely manner and hypoallergenic nutrition is prescribed, the symptoms of the disease can go away by 4-5 years.

In some children, it is possible that clinical symptoms increase with the external use of medicinal hormonal and non-hormonal drugs (Hydrocortisone and Prednisolone ointment, Fenistil-gel etc.). Babies can react sharply to substances taken by the mother that enter the baby's body during breastfeeding.

Children with toxicocoderma often experience severe malaise, loss of appetite, hyperthermia, increased weakness, etc. At diseases in children must be diagnosed in order to identify the causes of toxicoderma, as well as to exclude such diseases like neurodermatitis, pruritus, eczema, urticaria, etc. In addition, in case of severe development of the disease, it is necessary to exclude swelling of the brain.

Symptoms of the disease depending on the form of the disease

The severity of symptoms directly depends on the form of toxidermia:

SPOT. Spotted toxicoderma is characterized by rashes in the form of limited spots on the skin. Most often, erythematous spots are observed, much less often - hemorrhagic (purpura) and pigmented. Erythematous rashes with this type of toxidermia are in the form of a ring, roseola, dots, which have the property of merging into extensive erythema and are accompanied by itching, edema and desquamation. As a rule, the symptoms of this form proceed without serious complications. To relieve negative symptoms, non-hormonal ointments are prescribed.

PAPULE. Such toxicity is accompanied by the appearance of pointed papules, which can be of different sizes. In some cases, with anti-tuberculosis therapy, diabetes medications, and vitamin therapy, the rash may resemble shingles. With complications of toxicoderma, papules merge into single plaques. The patient notes excruciating itching and general deterioration. In this phase of the disease, increasing symptoms can be observed, and subsequently complications.

KNOTED. This type of toxicoderma often develops under the influence of sulfa drugs, as well as iodine, various vaccines and bromine. Elements of the rash appear in the form of blisters (urtiticuli), i.e. the blister has no cavity and rises above the surface of the skin due to the fact that swelling of the papillary layers of the dermis occurs. Edema develops as a result of exposure to bradykinin and serotonin, which are mediators of the inflammatory process. As a rule, these diseases are monomorphic, therefore, the elements of the rash are unstable and can disappear as quickly as possible and without a trace. As a rule, non-hormonal ointments and creams are prescribed.

In the case when dermal edema develops, increased lymphocytosis and an increased number of neutrophils are possible, which leads to general intoxication of the body and extensive skin lesions.

VESICULAR. The symptoms of this form of toxidermia are characterized by the appearance of vesicles surrounded by a corolla of erythema. In rare cases, vesicular toxidermia can be limited only to the lesion of the soles of the feet and palms. Most often it manifests itself as general dyshidrosis (a type of eczema). The severe course of toxicoderma is accompanied by vesicular erythroderma with edematous erythema, oozing, desquamation, formation scab, possible swelling of the extremities, Quincke's edema, etc. The addition of the secondary coccal flora and the formation of pustules.

EMPTY. Pustular toxidermia most often appears after taking drugs with a high iodine content, chlorine, bromine and fluorine, however, the disease can progress under the influence of any drug forms.

The main element of pustular toxidermia is a pustule located in the very center of an inflamed spherical papule. Often with toxidermia, rashes are localized on an area of ​​the skin located near the sebaceous glands (chest, face, back). This is due to the release of halogenated (capable of increasing the toxic effect on the sebaceous glands) chemical compounds.

Bullish. Bullous toxicoderma is most often observed after taking analgesics, antibiotics, tranquilizers and sulfonamides. With this form of toxicoderma, rashes appear in the form of blisters with hyperemic edges. (pemphigoid toxicoderma) or with localization in a certain area of ​​the skin (fixed toxicoderma). As a rule, fixed toxicoderma is characterized by an acute course. Despite drug therapy, sometimes fixed toxidermia can drag on for a long period of time.

Bullous symptomatology quite often accompanies the severe stage of toxicoderma, manifested by multiforme exudative erythema. Diagnosis of this form is difficult, since the patient's condition is extremely serious. There is a painful headache, critical hyperthermia, dizziness (up to loss of consciousness). In an extremely serious condition, cerebral edema is possible.

Tactics for the treatment of toxicoderma

Successful treatment of the disease depends on eliminating all contact with allergens. In adult patients, the main treatments are as follows:

• with mild toxicoderma (papular and spotty forms), non-hormonal drugs of local importance are prescribed (ointments, gels, lotions, etc.). These include Bepanten, Elidel, Actovegin;
• to remove sensitization in toxicoderma, it is recommended to use antihistamines (oral, intramuscular, intravenous). The most commonly used are Claritin, Erius, Zyrtec, Tavegil, Zodak, Suprastin;

• to neutralize toxic effects and the fastest possible elimination of an aggressive substance in a moderate severity of toxicoderma (vesicular and nodular form of the disease), the use of diuretics and laxatives is recommended (Furosemide, Hypothiazide, Fitolax, Duphalac, etc.);
• in severe cases of the disease (bullous form of toxicoderma and pustular), treatment of toxicoderma is indicated using intravenous infusions with hemodesis and plasmapheresis;
• in addition, with toxicoderma, hormonal therapy can be used in the form of ointments, tablets and solutions for injections (Lokoid, Hydrocortisone, Prednisolone, etc.);

• if the history of toxicoderma confirms a violation in the gastrointestinal tract, drugs are prescribed that restore the performance of these organs, focusing on the symptoms of the disease (Solcoseryl, Actovegin, Omeprazole etc.);
• toxidermia requires timely sanitation of foci of chronic infection. In addition, a special hypoallergenic diet is prescribed. When a secondary infection is attached, cerebral edema is possible, which requires emergency medical intervention.

If fixed toxidermia appears during pregnancy, immediate treatment is recommended to the attending physician, as damage to internal organs, systems and tissues is possible, which is dangerous for the mother and baby. Prescription of drugs for toxicoderma during pregnancy should be carried out directly by the doctor in order to minimize the risk to the fetus during the mother's pregnancy.

Diet

The occurrence of an acute allergic reaction in toxicoderma requires a complete revision of the diet in order to reduce allergic tension.

• Within 1 month after toxicoderma, it is not recommended to eat foods that are capable of irritate the mucous membranes of the digestive organs and require efforts from the body for them assimilation;
• it is recommended to use plant products and dairy dishes, but not more than 7 days in a row;
• a positive effect on the nutrition of the skin and the whole body during the development of toxicoderma is exerted by the inclusion in a diet of green salad, nettles, onions and a small amount of garlic (with previously removed core);
• boiled white meat (chicken, rabbit) and low-fat fish should be introduced into the diet gradually, starting with minimal portions;
• with toxicoderma of various etiologies, it is necessary to observe a water regime with plenty of drinking, excluding such drinks as tea and coffee. Still mineral water has a positive effect;

• toxicoderma can occur when drinking alcoholic beverages, chicken eggs, strawberries, honey, so these products should be excluded from the diet;
• in the acute stage of the disease, vegetable and fruit juices prepared at industrial enterprises should be abandoned. It is best to prepare juices yourself, avoiding exotic fruits and vegetables.

It should be noted that today toxicoderma is treated quite effectively, but after remission, as well as in the stage of exacerbation of the disease, it is recommended that a specialist be monitored. This will maximally protect the body from the negative effects of the allergen.