Erythema nodosum

Erythema nodosum is toxic-allergic vascular reaction to a variety of acute and chronic diseases and intoxication, among which the most important is streptococcal infection (chronic tonsillitis), and tuberculous intoxication. Characterized by the appearance of the skin of the lower legs, rarely thighs, upper arms inflammatory sites, accompanied by violation of the General condition of the patient.
Erythema nodosum usually occurs in childhood and adolescence. In adults is less common (mainly young women).

erythema nodosum
Erythema nodosum

Erythema nodosum, as a rule, is accompanied by rise of temperature to 38-39°, chills, pain in the joints loss of appetite, insomnia, rapid ROHE. On the extensor surfaces of the legs, and sometimes on other places, there are dense, semispherical shape nodes, which are located in the depth of the dermis or subcutaneous tissue, slightly above the level of the skin, from one to several centimeters in diameter. The color of the skin over the sites bright red, then as involution becomes brownish-red (Fig. 8), greenish-yellow, and sites disappear or leave temporary pigmentation. In some cases the result of peripheral growth and dissolution of infiltration in the centre hosts acquire a ring-shaped form (the migratory erythema nodosum), the collapse of nodes is not observed. The duration of the complete involution site about 10-15 days. The disease is acute (a few weeks), less chronic, when the periods of remission into the periods of exacerbation (usually in spring and autumn). The prognosis is favorable.
Treatment: bed rest, pain (analgin), antipyretics - acetylsalicylic acid (aspirin), vitamins C, P, chloride calcium. When identifying foci of focal infection- penicillin, at the rate of up to 8 000 000 IU or biomitsin, oxytetracycline (terramycin), at the rate of up to 12 000 000 IU; for suspected tuberculosis intoxication - tubazide or other (for the appointment of TB). In the case of chronic course of the disease - autohemotherapy. Naruzhno - 20% Ichthyol ointment, cotton wraps, compresses. Treatment usually performed in a hospital.
Prevention - early rehabilitation centers of a chronic infection.

Erythema nodosum (erythema nodosum; synonym: dermatitis contusiformis, erythema contusiforme) - a disease characterized by acute development knotted, painful when pressed rash on the skin of red colour with violet tint, with the flow looks like bleeding after injury.
Erythema nodosum is more common in children of preschool and school age, but old seeing it as dermatosis almost exclusively in children should be considered incorrect. Rates generally falls on spring and autumn.
The etiology and pathogenesis. In children erythema nodosum is often the first manifestation of TB infection ("paratuberculin reaction" by A. I. Strukova), in adults known etiological role of rheumatism. However, "pure" tuberculosis and rheumatic theory etiology erythema currently left. Most modern authors consider nodular erythema as polietiologic disease, as a kind of allergic reaction when the number of infections - tuberculosis, strep infections, rheumatism, mycosis (secondary rash if plicarum and deep trihofitii, coccidioidomycosis), aftosa and acute ulcer of the vulva, malaria, leprosy, gonorrhea and other Nodular erythema in adults sometimes see when sarcoidosis, often it is an early manifestation of acute beginning mediastinal-pulmonary forms of sarcoidosis. The so-called Lofgren's syndrome, characterized by the combination of erythema nodosum with bilateral symmetrical increase bronchopulmonary lymph nodes and anergy to tuberculin, often with fever, is a manifestation of sarcoidosis. A. S. Raben relates nodular erythema among non-specific skin lesions with sarcoidosis.
Erythema nodosum may develop after taking the drugs - iodine, bromine, sulfa and some anti-malarial drugs. More often women.
Pathological anatomy. In the dermis - moderate perivascular infiltration, mainly lymphoid cell. The main changes are localized in subcutaneous adipose tissue. In an early phase in the subcutis find scattered clumps of lymphoid cells and a moderate amount of neutrophils, which are located in fibrous septae between the fat lobules, and also between the fat cells. Some histiocytes and sometimes eosinophils, plasma cells there. On the resulting nodes are massive infiltration located, however, only in some parts. Abscesses and necrosis not.
Can be fibrinogene change of the collagen fibers. Both phenomena of vasculitis - destruction of the walls of both arteries and veins. In the opinion of the Lever (W. F. Lever), morphological changes during nodular erythema may represent a response to the antigen-antibody on infectious agent.


The clinical picture. The most frequent localization - shins, especially their front surface, less thighs and buttocks. Sometimes after a previous ailments within 1-2 days of acute, often with chills and fever to temperature 38-39°, develop symmetrically located, dense, slightly raised above the surface of the skin soft delimited flat and hemispherical nodes red 2-3 cm in diameter, painful when pressed. The colour of nodes is changing rapidly: in 2-3 days they get lividly, then brown, yellow and green hues (like involution hematoma). All over usually takes 1,5-2 weeks, units disappear without a trace, leaving passing hyperpigmentation. The sites often recur, sometimes there is a chronic course: to change the extinct new elements in the same places or other (erythema nodosum migrans). In the period rash patients, in addition to fever, often celebrate insomnia, loss of appetite, gastrointestinal disorders, pain in muscles and joints; often accelerated ROHE.
Sometimes the rash of nodes is accompanied by sore throat, pharyngitis, rhinitis, bronchitis, however, a common phenomenon can be minimal.
The diagnosis is based on the acute onset and characteristic involution nodes. From erythema compacted (Bazin) erythema nodosum is no seal sites, from non-inflammatory paniculata (syndrome Pfeifer - Weber - Christian - best overall condition and over, erythema multiforme exudative - absence of polymorphism rash and typical localization process.
Sometimes it is necessary to carry out differential diagnosis of erythema nodosum with snobishly (perniones), phlebitis, popularisations tuberculosis skin, nodular nodosa. In the prodromal period diagnosis difficult.
The prognosis is favorable; recovery depends on the underlying disease. Possible relapse.
Treatment. In the acute period required bed rest. The main attention should be paid to identifying and treating the underlying disease (sanitation foci of infection, anti-tuberculosis and anti-rheumatic drugs respectively in these diseases, corticosteroids with sarcoidosis, and so on).
Appropriate designation of sulfa drugs (especially for migratory form), aspirin (acetylsalicylic acid), salicylates (3-4 g salicylic sodium per day), penicillin. Treatment with corticosteroids in the absence of sarcoidosis, according to B. A. Pratusevich, accelerates involution sites, but does not prevent their recurrence. Locally appointed 10-20% Ichthyol ointment, dry heat, UHF.
Prevention of erythema nodosum is to timely readjustment of the body (from the centers of a chronic infection).