Erythema

Red spot introduction Erythema is a local or systemic red spotted rash that is localized or systemicly dilated by the dermal papillary capillary network. Internationally named, refers to the bright red and velvety plaques on the oral mucosa. It can not be diagnosed as other diseases in clinical and pathological manner. Oral erythema does not include local infectious inflammation, such as tuberculosis and mold infection. The age of oral erythema is the highest in the age range of 41 to 50 years old. The diseased part is the highest in the tongue, the sputum, the buccal sulcus, the bottom of the mouth and the lingual abdomen, and the ankle is the second. It is clinically divided into homogenous erythroplakia. Interspersed erythroplakia, granular erythroplakia (granularerythroplakia) three types. basic knowledge Sickness ratio: 0.0001% Susceptible people: no special people Mode of infection: non-infectious Complications: polymorphic erythema

Erythema etiology

Drug factor (15%)

It mainly refers to those who have allergies, they are prone to allergic reactions after using certain drugs, and there are many kinds of common sensitizing drugs such as sulfonamides, such as erythema, blisters, erosions, etc., which appear on the skin and mucous membranes. , antibiotics, barbiturates, phenylbutazone, antipyretics, randin or carbamazepine.

Immunity factor (10%)

Many scholars have studied the relationship between immunity and erythema, suggesting that immune factors are also a possible factor in the pathogenesis. For example, Kraeger et al (1973) measured macrophage aggregation activity (MAA) in 5 patients with polymorphic exudative erythema, 2 of which increased SAAa et al (1975) reported two cases from clinical and histological The IgG in serum and blister fluid was elevated in patients with bullous polymorphic exudative erythema diagnosed; while in the early blister fluid, the complement component decreased and the immune complex increased.

Virus infection (10%)

Soltz-Szots (1963) reported that polymorphic exudative erythema was induced by herpes simplex virus vaccine in the treatment of recurrent herpes simplex. Shelley (1967) subcutaneously injected with herpes simplex virus vaccine 0.01ml, replicating polymorphic exudative erythema occur. In addition to herpes simplex virus, Coxsackie virus, measles virus, and Echovirus poliovirus can be used as antigens to induce the disease, so polymorphic exudative erythema is recognized as an allergic reaction.

Bacterial infection (12%)

It is mainly caused by S. pyogenes infection as an antigen. Including hemolytic streptococcus, Staphylococcus aureus, diphtheria, bacterium such as erysipelas.

Mycoplasma infection (5%)

It is currently believed that Mycoplasma pneumoniae is a pathogenic pathogen such as Lyell et al. (1967) isolated Mycoplasma pneumoniae from 2/13 cases of erythema of severe polymorphic exudative erythema, and the complement-binding antibody titer is elevated. Mycoplasma pneumoniae and Mycoplasma mycoplasma type I were isolated from the oropharynx of 5 other patients with polymorphic exudative erythema.

Other factors (3%)

Such as the patient's mental fatigue, food allergies, infections caused by cold, etc. can induce the disease.

Red spot prevention

prevention:

1, try to avoid allergens, take some sensitizing drugs must be careful to prevent allergies caused by erythema.

2, strengthen physical exercise, enhance their own resistance, can effectively prevent the occurrence of erythema and various diseases.

3, eat more fungi foods, fungi foods have the role of regulating immunity, so it can enhance their own immunity.

4, try to ensure the law of life, good living habits are conducive to physical and mental health.

5. Do an allergen check and PPD check.

Precautions:

1. Strictly control the number of companions and the number of visits. Use the chlorine-containing disinfectant to wet the floor of the ward 1~2 times/d and wipe the bedside table, chair, door and window once/d. The sheets, quilt cover and clothes are all used after autoclaving, and replaced in time. It is suitable to take cotton products. Before and after all treatment, examination and care, the medical staff cleaned their hands in time and disinfected them with new Jie Ling. The thermometer, sphygmomanometer, etc. are fixed and used for education.

2, encourage the suffering of drinking more water, urinating to wash the urethra naturally, to prevent urinary tract infection. For those who have dysuria, use hot compress, listen to the sound of running water or gently press the bladder area to help them solve the problem. Wash the eyes with a cotton swab dipped in normal saline, pay attention to remove secretions, peeling suede and eyelashes, and then use rifampicin, tobacco or oxicam, eye drops, alternate use, 2 to 3 times / d The two collaborated to complete.

Erythema complications Complications polymorphic erythema

If the disease is not treated in time, it may be complicated by carcinoma in situ or invasive cancer.

Symptoms of erythema common symptoms diffuse hyperemia of the oral mucosa

The age of onset of oral erythema is the highest in the age range of 41 to 50 years old. The incidence of the disease is the highest in the tongue, the sputum, the buccal sulcus, the bottom of the mouth and the lingual abdomen, followed by the ankle. It is clinically divided into homogenous erythroplakia. , interspersed erythroplakia, granular erythroplakia three types:

First, homogeneous erythema

The lesion is soft, bright red, smooth surface, no particles, no keratinized surface, red light, like "no skin", damage flat or micro-lift, clear edge, range often is large soybean or broad bean, erythema area can also Contains a mucous membrane with a normal appearance.

Second, inter-type erythema

There are scattered white spots on the base of the erythema. It is clinically seen in red and white, similar to lichen planus.

Third, granular erythema

In the velvet-like area or in the periphery, scattered punctate or plaque-like white keratinized areas (this type, ie, granule leukoplakia) are visible, slightly above the mucosal surface, and there are small microscopic nodules resembling mulberry-like or granular granulation. On the surface, tiny nodules are red or white, and this type is often carcinoma in situ or early squamous cell carcinoma.

Red spot check

Pathological examination showed that the epithelial incomplete keratinization or positive keratinization was mixed with incomplete keratinization. The keratinized layer was extremely thin or even absent. There were 2 to 3 layers of spinous cells on the papillary layer, so that the nipple was very close to the epithelial surface, and the capillaries were obviously expanded. The lesions are bright red. In addition to epithelial atrophy, there are epithelial hyperplasia, increased nail elongation, thinning of the epithelium between the nails, and the connective tissue closer to the surface. The mechanism of particle formation is that the surface of the nail enlargement forms a depression, while the high-throate connective tissue nipple forms red particles, the epithelial cells are disorderly arranged, the polarity disappears, the cell morphology is different, the spine cells shrink, and the nucleus is deeply stained. Epithelial dysplasia such as increased mitotic phase, infiltration of inflammatory cells in lamina propria, mainly lymphocytes and plasma cells, keratinocytes in the epithelial layer, large nucleus, strong eosinophilic cytoplasm, sometimes horny beads, Granular erythema is mostly carcinoma in situ or early squamous cell carcinoma that has already protruded from the basement membrane.

Red spot diagnosis

diagnosis

Typical velvety erythema is not difficult to diagnose, but the red and white inter-hybrid leukoplakia is easily diagnosed as "lichen planus". The granular micro-nodules are sometimes white, sometimes red, and white is often diagnosed as "white spots". Granular leukoplakia, which plays an important role in the diagnosis of histopathology. Toluidine blue is used for staining in oral suspected wards, because toluidine blue can bind to DNA and RNA, and when the nucleic acid is increased in a large amount, it appears dark blue. It indicates that the cell nucleic acid metabolism in this area is active. It is a simple, rapid, economical and painless method for examining early cancer. After washing, it is washed with 1% acetic acid water to reduce the false positive of toluidine blue staining. Repeated staining of the positive area, where biopsy specimens were taken, more accurate.

Differential diagnosis

First, lichen planus

The variability of the edge of lichen planus often causes white streaks or reticular damage around the reddish area, which is often symmetrical and can occur in multiple places. The mucosa of the lesion area is flat, the white line is slightly higher, the erosion can heal, and the basal layer liquefaction is examined pathologically. Denatured, there is a lymphocyte infiltration zone in the lamina propria, and the erythema has a clear margin, a fixed range, a lesion higher than the mucosa, or flat with the mucous membrane, or eroded, velvety-like surface, granule, nodule, granulation, frosted surface, Non-healing, pathological examination of epithelial atrophy, epithelial hyperplasia, carcinoma in situ, invasive carcinoma, keratinocytes in the epithelium, sometimes with horny beads.

Second, white spots

Generally slightly higher than the mucosal surface, remove possible stimulating factors, relieve symptoms, can be plaque, granules, wrinkles paper or sputum, generally no symptoms, consciously local rough, spontaneous pain and irritation when there is ulceration Pathological examination of epithelial hyperplasia, obvious granules, thickening of the spinous layer, enlargement of epithelial nails, infiltration of inflammatory cells in connective tissue, abnormal epithelial hyperplasia, erythema with white spots on the basis of red lesions, or white On the matte surface, the lesion does not heal. In addition to the abnormal hyperplasia of the epithelium, pathological examination also has carcinoma in situ or invasive carcinoma.

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