RU-2861621-C1 - METHOD FOR TREATING ERYTHEMA MULTIFORME EXUDATIVE WITH LESIONS OF ORAL MUCOSA

Abstract

FIELD: medicine; therapy. SUBSTANCE: invention can be used in the treatment of erythema multiforme exudative with lesions of the oral mucosa. The method includes antihistamine therapy, wherein the first course lasting up to 10 days is carried out with first-generation antihistamines - promethazine at a dosage of 0.025 g twice a day or diphenhydramine at a dosage of 0.05 g twice a day, followed by a second course of antihistamine therapy with a second-generation drug - cetirizine at a dosage of 0.01 g once a day for up to 4 weeks. At a body temperature above 38°C, non-steroidal anti-inflammatory drugs are used - ibuprofen at a dosage of 0.2 g three times a day or metamizole sodium at a dosage of 0.5 g three times a day after meals for 1-3 days, discontinuing after fever subsides. Also using calcium preparations – 10% calcium gluconate solution 10 ml intravenously once a day for up to 10 days or calcium gluconate tablets 0.5 g 3 times a day or calcium carbonate with vitamin D3 0.5 g 2 times a day for up to 1 month. Carrying out detoxification therapy by intravenous infusion of 0.89% sodium chloride solution 800 ml daily for 5-10 procedures, hyperbaric oxygenation for a ten-day course in a regime of 0.17 MPa with an exposure of 45 minutes daily, enterosorption by conducting a course of 4-5 days orally three times a day of hydrolytic lignin with lactulose. After relief of acute manifestations of erythema multiforme exudative, for the prevention of seasonal relapses of the disease 2 times a year, in spring and autumn, taking orally hydrolytic lignin with lactulose. Additionally using local treatment of erythema multiforme exudative, applying a 5% aqueous solution of chymotrypsin to the area of the inflamed oral mucosa once for 30 minutes, and then conducting a course of applications of poviarcol, as well as treating the affected elements of the oral mucosa with a spray containing mometasone furoate. Also, on erosions of the oral mucosa and the red border of the lips, applying keratoplastic agents – sea buckthorn oil on cotton wool for 20 minutes 3 times a day until complete epithelialisation of the affected elements. EFFECT: rapid relief of the inflammatory process of the oral mucosa and the red border of the lips, shortening the treatment time of the disease, stable remission of erythema multiforme, expressed in the absence of seasonal relapses of the disease. 1 cl, 4 dwg, 2 ex

Inventors

• KOVALEVSKII Aleksandr Mechislavovich
• Zhelezniak Vladimir Andreevich
• POLEShchUK Ekaterina Vadimovna
• Ustinov Dmitrii Andreevich

Dates

Publication Date

20260506

Application Date

20250722

Claims (1)

1. A method for treating erythema multiforme exudative with lesions of the oral mucosa, characterized in that antihistamine therapy is administered, with the first course lasting up to 10 days being administered with 1st generation antihistamines - promethazine at a dosage of 0.025 g twice daily or diphenhydramine at a dosage of 0.05 g twice daily, followed by a second course of antihistamine therapy with a 2nd generation drug - cetirizine at a dosage of 0.01 g once daily for a course of up to 4 weeks; at a body temperature above 38°C, non-steroidal anti-inflammatory drugs are used - ibuprofen at a dosage of 0.2 g three times daily or metamizole sodium at a dosage of 0.5 g three times daily after meals for a course of 1-3 days, with discontinuation of administration after the fever disappears; and also use calcium preparations - 10% calcium gluconate solution, 10 ml intravenously once a day for up to 10 days, or calcium gluconate tablets, 0.5 g 3 times a day, or calcium carbonate with vitamin D3, 0.5 g 2 times a day for up to 1 month; conduct detoxification therapy by intravenous infusion of 0.89% sodium chloride solution, 800 ml daily for a course of 5-10 procedures; hyperbaric oxygenation for a ten-day course at 0.17 mPa with an exposure of 45 minutes daily; enterosorption by conducting a 4-5-day course of hydrolytic lignin with lactulose orally three times a day an hour before meals with the fourth dose at night in the age-appropriate dosage, while adults receive at least two tablets per dose, and the remaining medications are taken after meals; after the acute manifestations of erythema multiforme exudative, in order to prevent seasonal relapses of the disease, 2 times a year, in spring and autumn, hydrolytic lignin with lactulose is taken orally 4 times a day - three times one hour before meals and an additional 2-3 tablets at night for a course of 4-5 days; Additionally, local treatment of erythema multiforme exudative is used: a single application of a 5% aqueous solution of chymotrypsin is performed on the area of the inflamed oral mucosa for 30 minutes, followed by a course of applications of poviargol - a metal-polymer composition containing highly dispersed metallic silver and a polymer stabilizer polyvinylpyrrolidone, diluted in sterile distilled water to a concentration of 6% for 30 minutes 8 times a day until the manifestations of the disease completely disappear; and also treat the affected elements of the oral mucosa with a spray containing mometasone furorate twice a day for 3-7 days, then a single daily treatment of the mucous membrane with a spray is performed for 3-4 days, after which the prescription is discontinued; Also, on the erosions of the oral mucosa and the red border of the lips, keratoplastic agents are applied - sea buckthorn oil on cotton wool for 20 minutes 3 times a day until the affected elements are completely epithelialized.

Description

The invention relates to medicine, namely to therapeutic dentistry, and can be used in the treatment of erythema multiforme with lesions of the oral mucosa. Relevance. Erythema multiforme (EM) is an acute immune-mediated inflammatory reaction of the skin and, in some cases, mucous membranes to various stimuli, characterized by target lesions with peripheral localization, prone to recurrence and self-resolution [Erythema multiforme: clinical guidelines [Electronic resource] / A.A. Kubanov, I.A. Gorlanov, D.V. Zaslavsky, A.V. Samtsov, R.V. Khairutdinov. - All-Russian public organization "Russian Society of Dermatologists and Cosmetologists". - M., 2024. - 21 p. - Access mode: URL: http: // https: // www.rodv.ru/klinicheskie-rekomendacii/ 4e33346935c9967275e5911f72a4940f. – 26.03.2025]. Erythema multiforme (EM) of the oral mucosa is an acute inflammation of the oral mucosa (OM) and the red border of the lips (RBG) that develops in patients with mucocutaneous dermatosis and is accompanied by the formation of polymorphic (erythematous, bullous, urticarial, papular) primary elements of the lesion, manifested by the same type of clinical symptoms and prone to recurrence [Erythema multiforme: manifestations in the oral cavity: clinical guidelines [Electronic resource] / T.V. Vilova, L.N. Kuzmina, G.F. Ovodova, L.N. Maksimovskaya, G.I. Lukina, M.Ya. Abramova. - Association of Public Organizations "Dental Association of Russia", 2022. - 44 p. - Access mode: URL: http: // https://e-stomatology.ru/director/protokols/. – 30.01.2025]. The most common cause of erythema multiforme is considered to be the herpes simplex virus (HSV), but Epstein-Barr virus, adenoviruses, hepatitis B and C viruses, mycoplasma, bacteria and fungi can also play a causative role. The cause of the disease can be systemic diseases: sarcoidosis, periarteritis nodosa, Wegener's granulomatosis, lymphoma, leukemia. The inflammatory process in ME is caused by sensitized T-helpers (CD4+ T-lymphocytes) [Erythema multiforme: manifestations in the oral cavity: clinical guidelines [Electronic resource] / T.V. Vilova, L.N. - Association of public associations "Dental Association of Russia", 2022. - 44 p. – Access mode: URL: http: // https://e-stomatology.ru/director/protokols/. – 01/30/2025; Adenovirus-induced Erythema Multiforme: eye and genital mucosal involvement is specific, whereas oral and cutaneous involvement is not / A. Calas, C. Lheure, C. Bernigaud, J.F. Meritet, P. Sohier, J. Augustin, C. Isnard, N. Franck, G. Royer, S. Ingen-Housz-Oro, N. Dupin // Acta Derm. Venereol. – 2020. – Vol. 100, No. 13. – P. 1–2]. At the same time, a toxic-allergic form of ME is distinguished, the cause of which is usually medications, sulfonamides, including in combination with trimethoprim [Tagi S.A. Drug-induced oral erythema multiforme: a diagnostic challenge / S.A. Tagi // Ann. Afr. Med. - 2018. - Vol. 17, No. 1. - P. 43-45], amidopyrine, antibiotics [Arnold M. A case of erythema multiforme major following administration of ciprofloxacin ophthalmic drops / M. Arnold, M. Wilkerson // Dermatol. Online J. - 2017. - Vol. 23, No. 10. - P. 13030 /qt49k2k7xt. / https: // pubmed.ncbi. nlm.nih.gov. / 29469784. – 17.07.2023], barbiturates, and more recently – a vaccine against Covid-19 [Katayama Sh. Erythema multiforme after BNT162b2 vaccination / Sh. Katayama, M. Ota // Intern. Med. – 2022. – Vol. 61, No. 12. – P. 1929] and a pneumococcal vaccine [Erythema multiforme following pneumococcal vaccination / A. Monastirli, E. Pasmatzi, G. Badavanis, D. Tsambaos // Acta Dermatovenerol. Alp. Pannonica Adriat. – 2017. – Vol. 26, No. 1. – P. 25–26]. It is recommended to diagnose the toxic-allergic form of ME SOR in the presence of sensitization to sulfonamides, acetylsalicylic acid, NSAIDs for systemic use (analgin, butadion), progesterone, antibacterial drugs for systemic use - tetracycline, phenoxymethylpenicillin, quinolones / fluoroquinolones, cephalosporins in order to adjust therapy [Erythema multiforme: manifestations in the oral cavity: clinical guidelines [Electronic resource] / T.V. Vilova, L.N. Kuzmina, G.F. Ovodova, L.N. Maksimovskaya, G.I. Lukina, M.Ya. Abramova. - Association of Public Associations "Dental Association of Russia", 2022. - 44 p. - Access mode: URL: http: // https://e-stomatology.ru/director/protokols/. – 30.01.2025]. The goal of Erythema multiforme: oral manifestations: clinical guidelines [Electronic resource] / T.V. Vilova, L.N. Kuzmina, G.F. Ovodova, L.N. Maksimovskaya, G.I. Lukina, M.Ya. Abramova. - Association of Public Organizations "Dental Association of Russia", 2022. - 44 p. - Access mode: URL: http: // https://e-stomatology.ru/director/protokols/. - 30.01.2025]. Treatment of ME is divided into stopping the acute disease (or a developed relapse) and preventing its seasonal recurrence [Grigoriev D.V. Erythema multiforme exudative, Stevens-Johnson syndrome and Lyell's syndrome - a modern interpretation of the problem / D.V. Grigoriev // RMZh. - 20