How to treat erythema on the legs. What is erythema nodosum and what are the treatments. Possible consequences and complications

Erythema nodosum is a disease of the connective tissue, in which its inflammation occurs with damage to the skin. The disease manifests itself in the form of symmetrically located bumps under the skin. The disease occurs more often in women than in men, mostly between 20 and 40 years of age. The disease can also occur in childhood, mainly in girls older than 6 years.

Most often, the disease manifests itself during pregnancy or when taking contraceptives, as hormonal changes occur in the body. In addition, erythema nodosum can be a symptom of a serious pathology, so you should consult a doctor as soon as possible with such a disease.

In total, there are three types of erythema nodosum:

• Acute;
• chronic;
• migratory.

Most often, acute nodular erythema of the lower extremities occurs. Nodules begin to appear on the legs, symmetrically on both legs. When pressed, they are painful, in addition, the disease develops suddenly, the general condition worsens, temperature can be understood, and weakness occurs throughout the body.

In addition, the nodules themselves turn red, swell. If inflammation occurs near the joint, then it is quite possible to involve it in the process, then the pain intensifies, the motor activity of the limb is impaired, the general condition of the patient worsens. Over time, the nodes decrease, redness subsides, and yellowish spots remain on the skin that resemble bruises.

Chronic erythema most often occurs in women over 45 years of age, who have a history of various tumors, chronic infections in the body. Unlike acute erythema, the disease disappears without deterioration in general well-being, nodules are not visible externally, the skin does not turn red and does not become inflamed. Pain and obvious signs of an inflammatory process can occur during an exacerbation of the disease.

With migrating nodular erythema, the symptoms are rather blurred, the temperature does not rise much, the person feels general weakness. In this case, the node appears alone, it does not increase much, and can migrate, leaving pale plaques.

The reasons

Erythema nodosum can be an independent disease in some cases, while in others it indicates the presence of a serious pathology. People with a genetic predisposition are more prone to developing the disease, in addition, various infectious and non-infectious diseases can provoke the disease:

• Inflammation of the intestines;
• Sarcoidosis (specific inflammation of organs, often the lungs);
• The presence of neoplasms;
• Blood cancer;
• Hodgkin's lymphoma;
• Tuberculosis;
• Chlamydia;
• Syphilis;
• Toxoplasmosis;
• Hepatitis and other infectious diseases.

Women are also more susceptible to the disease during pregnancy. This is due to a weakening of the immune system and changes in the hormonal background of a woman, as a result, the body cannot normally deal with various negative factors, and a reaction occurs in the form of erythema nodosum.

The cause of the disease in children most often becomes a weakening of the immune system in the off-season and the addition of a viral or bacterial infection. In children, the course of the disease is more pronounced, the baby does not eat, is naughty, the body temperature rises, there is a headache and characteristic nodes under the skin.

Symptoms

The main symptom of the disease is the appearance of nodules under the skin, which are located symmetrically. Their size can vary from a few millimeters to five centimeters. At the same time, the skin around the nodes is quite smooth, does not peel off, but turns red, and the border of the nodules is blurred, although they stick out.

In the acute course of the disease, the nodes are quite pronounced, but in the chronic form they can only be detected by touch or during an exacerbation. The nodes grow rapidly, then the growth stops abruptly and they no longer increase, the growth limit of each node may vary.

With nodular erythema, the patient is concerned about pain, they can be expressed in different ways. In one case, the pain appears only when pressing on the bump, in the other, discomfort is constantly disturbing. The strength of pain also varies, they can be weak, and do not bother the patient at all, or cause a lot of inconvenience.

In the first 2-3 days after the appearance of the nodes, the skin around them is red, inflamed, but does not itch. On average, after three days, the redness begins to disappear, and the nodes disintegrate, the skin around the affected area turns blue and then yellow, this is very similar to a healing hematoma.

You can also highlight a number of symptoms that occur during the disease in most cases:

• Increase in body temperature;
• General malaise;
• Chills;
• Refusal to eat;
• exhaustion;
• Pain in the joints, sometimes with obvious signs of inflammation.

Depending on what provoked the disease, a consultation of various narrow specialists, for example, a phlebologist, an ENT specialist, an infectious disease specialist, etc., may be prescribed. X-rays of the lungs are often prescribed to determine the presence of tuberculosis or sarcoidosis.

Treatment

The treatment regimen is selected individually, depending on the results of the examination and the identified pathologies. If the disease provoked any pathology, then first of all the patient is referred to the appropriate specialist, who confirms the diagnosis and prescribes a specific treatment.

Typically, the patient is prescribed non-steroidal anti-inflammatory drugs, antibiotics, anti-inflammatory ointments, antihistamines, and physical therapy visits. The exact dosage of medicines is calculated by the specialist, taking into account the severity of the disease. In the process of treatment, the patient must comply with bed rest, active physical movements are prohibited.

The most commonly used NSAIDs are Ibuprofen, Diclofenac, Aspirin. The use of glucocorticosteroid drugs may also be indicated to quickly suppress inflammation and pain. For local treatment, hormonal ointments are used. Phonophoresis, laser and magnet treatment, compresses with ichthyol are shown as physiotherapy.

Erythema nodosum is not a contagious disease, so no special measures are required. But pathology often occurs along with infectious diseases, in which case it may be necessary to consult an infectious disease specialist and even hospitalization in an infectious diseases hospital.

To restore the body, doctors prescribe immunomodulators, vitamin complexes. Nutrition also plays an important role, it must be correct, satisfying enough and tasty so that a person receives a sufficient amount of the substances necessary for the body.

During the treatment period, traditional medicine recipes can also be used, but only after consulting a doctor. Herbal lotions will help reduce the symptoms of erythema nodosum of the lower extremities, and speed up tissue healing. But do not forget that folk remedies cannot cure the infection, so there should not be any initiative in this case, it is dangerous to health.

Pregnancy

Very often, erythema occurs in pregnant women and is accompanied by infectious diseases. A couple of decades ago, such a pathology was considered fatal to the fetus, so mothers were offered abortion. In our time, such drastic measures are used only in extreme, and very severe cases, this rarely happens.

During pregnancy, there are some problems with the treatment of the mother, this is due to the fact that almost all drugs are prohibited. Local anti-inflammatory and analgesics, ointments and compresses are usually prescribed. In addition, the expectant mother is forbidden to be exposed to stress, bed rest is prescribed.

But after the birth of the baby, the mother must definitely undergo an examination and, if necessary, undergo a full course of treatment, since the disease can easily turn into a chronic form and torment the patient with relapses for the rest of her life.

Forecast

With timely admission to the hospital and after undergoing treatment, most often there is a complete recovery, and the patient's illness no longer bothers, there are no traces of rashes. By itself, erythema is not dangerous, the diseases that accompany it are dangerous, therefore it is necessary to consult a doctor and preferably immediately, as soon as the first signs of the disease were discovered. Dermatologists are involved in the initial examination for such a disease, you can also contact a general practitioner, a general practitioner will refer you to the right specialist.

About the disease (video)

In recent decades, there has been an unpleasant trend of increasing the number of people suffering from various skin diseases. No one has yet been able to give a reliable explanation for this phenomenon. Among such problems as eczema, papillomas, age spots, acne and rash, there is also a rather rare disease - erythema nodosum. What it is, what it looks like, what is dangerous and how to treat - read below.

Erythema nodosum is quite rare.

What is erythema nodosum disease?

Erythema nodosum on the legs is an inflammatory skin disease, caused by the formation of painful subcutaneous seals on the legs and in places of accumulation of adipose tissue. Usually localized in the deep layers of the epithelium and adipose tissue, leads to inflammation of the subcutaneous blood vessels.

The first mention of the term "nodular erythema" falls on 1807. The name was introduced by the British dermatologist Robert Willan. Later, more detailed studies of the nature of the disease were carried out, which made it possible to determine erythema to the group of allergic vasculitis.

The disease manifests itself massively or individual seals are observed (often symmetrically located). A larger percentage of places of education falls on the lower limbs. People from 20 to 35 years old are susceptible to the disease. Most of the patients are young women. Adult men suffer from erythema three times less often. However, among adolescents of both sexes during puberty, the frequency of visits to a dermatologist with the above problem is equally equal.

Erythema nodosum is more common in women

Causes of the disease

It was found that erythema nodosum is a disease based on an allergic nature. The main causative agent of inflammatory processes, which triggers the formation of seals under the skin, is an infection. The development of the disease is observed against the background of tonsillitis, otitis, pharyngitis, scarlet fever. Albeit to a lesser extent, the following factors can provoke an ailment:

• taking antibiotics, iodides, bromides;
• allergy to sulfonamides;
• consequences of vaccination;
• sarcoidosis;
• intestinal ulcerative colitis;
• oncology;
• Behcet's disease;
• the period of pregnancy, subject to the presence in the body of chronic infectious processes;
• inguinal lymphogranulomatosis;
• leprosy.

It is also noted that in one family, erythema nodosum of the lower extremities can be repeated in several generations. Therefore, the factor of genetic disposition or heredity is additionally isolated.

Types of erythema nodosum

A classification of types of erythema has been developed depending on the causative agent of the disease and the clinical picture. This division will allow you to make the most accurate diagnosis and choose the right treatment.

There are the following types:

toxic

Typical for newborns. Refers to the physiological norm, which manifests itself in the first days of life in the form of skin rashes. Other symptoms, except external, are not observed. Treatment of toxic erythema is not required, as the formations disappear on their own within a week.

Toxic erythema nodosum occurs in newborns

infectious

Accompanies infectious diseases of unknown etiology. The main causative agent is streptococci. It occurs in people of all ages and gender.

Multiform exudative

Subcutaneous seals appear and progress against the background of colds. Erythema nodosum is accompanied by symptoms similar to ORS: headache, weakness, malaise, sore throat and joints. Painful nodules appear on the palms and arms, feet, legs, oral mucosa and genital organs. A distinctive feature of exudative erythema is subcutaneous seals of a clearly defined shape, often filled with serous fluid.

If such a papule bursts, bleeding ulcers form in its place. In the absence of any treatment, serious complications, up to and including death, can occur.

migratory

This type of erythema is one of the symptoms of Leim's disease. The disease is characteristic of a tick bite. At the site of the bite, ring-shaped erythema is formed - a rapidly growing form. In the center of the formation, the skin is paler than at the edges.

annular

A disease of a chronic form, which is based on an infection, intoxication or an allergic reaction. The name was given as a result of the fact that numerous red plaques accumulate in conglomerates and form peculiar rings on the skin. This type of disease occurs more often in young men.

Erythema nodosum annulare is a chronic disease.

Clinical picture

The main and main symptom of erythema nodosum is the formation of numerous dense nodules in the deep layers of the dermis and fiber. Seal sizes vary from 5 to 50 mm. The surface of the skin over the formations is smooth, but has a pronounced red tint. On palpation, and sometimes visually noticeable, how the nodes rise above the surface of the skin. More often, such tubercles do not have clearly defined boundaries as a result of swelling of regional tissues. Erythema nodosum has the ability to grow rapidly, but having reached a certain size, the nodes stop growing.

Pain syndrome manifests itself in different ways. Sometimes the pain is felt when touched or palpated, in other cases it occurs spontaneously and in waves, regardless of external influences. Periods of exacerbation of the disease fall in autumn and winter.

After 4-6 days, the formed "bumps" of red color begin to behave like a normal hematoma. The shade of the skin over the node changes to cyanotic with pink, green and then yellow.

Erythemas are formed in the vast majority of cases on the lower extremities, but can also appear on the thighs, buttocks, trunk, arms, genital mucosa, neck, face, and rarely on the eyeball.

Forms of erythema

Nodular erythema on the legs has two forms: acute and chronic. The symptoms are different. The acute form is characterized by:

• fever, fever;
• chills;
• loss of appetite;
• general weakness.

Many patients have arthropathy - inflammation of the regional joints. There is stiffness in the morning, pain on movement or palpation. The joint swells, redness appears, intra-articular effusion is possible.

The acute form can last from two weeks to a month, depending on the severity of the course of the disease and associated complications. After this period, seals are allowed. In places of their localization, hyperpigmented spots or scaly skin islands remain.

Chronic erythema nodosum is a rarer form of the disease. It is characterized by an undulating course with periods of remission and relapses. In moments of exacerbation of the disease, single nodes of a cyanotic color appear. Typically, periods of relapse last up to several months. Chronic disease often goes in tandem with chronic arthropathy.

Arthropathy often accompanies erythema

Diagnostics

Diagnosis begins with an examination of the patient. Without fail, the patient is assigned a set of tests and laboratory tests, with the help of which the differentiation of the disease is made, the causes and concomitant ailments are clarified. If the patient has an acute form or exacerbation of chronic erythema, a blood test is performed. The level of ESR and the presence of neutrophilic leukocytosis are checked. Bacterial culture of samples from the nasopharynx or feces is carried out to detect streptococcal infection in the body or yersiniosis, respectively. To exclude tuberculosis, the patient is sent for tuberculin diagnostics. If the patient complains of pain in the joints, an examination by a rheumatologist is performed.

Sometimes it is not possible to make a diagnosis, and on the basis of clinical signs, it is not possible to make a diagnosis. In these cases, a biopsy of the inflamed area is prescribed. By decision of the doctor, the patient may undergo:

• rhinoscopy;
• pharyngoscopy;
• rheovasography;
• X-rays of light;
• Ultrasound of the blood vessels of the lower extremities.

Based on the results obtained, treatment is prescribed.

Rheovasography is used to diagnose erythema

Conservative treatments

The success of therapy depends on how correct the treatment of the disease and concomitant pathological processes was chosen. Effective therapy has simultaneously three directions of influence:

• relief of erythema nodosum syndromes;
• local treatment of nodes;
• elimination of the root cause of the disease.

If a patient is diagnosed with erythema nodosum on the legs, treatment includes taking the latest generation of antibiotics, antihistamines and desensitizing agents. Non-steroidal anti-inflammatory drugs are prescribed to eliminate inflammatory processes. At the discretion of the doctor, procedures such as:

• cryopharesis;
• extracorporeal hemocorrection;
• laser irradiation of blood;
• plasmapheresis and others.

Local treatment is aimed at accelerating the processes of disintegration of nodes in the subcutaneous layer. For these purposes, corticosteroid and anti-inflammatory ointments are prescribed, ultraviolet irradiation, magnetotherapy, and phonophoresis are prescribed. Additionally, vitamins of the P, E and C groups, preparations with calcium and potassium iodide are prescribed.

With a strong pain syndrome, analgesics are prescribed in the form of injections or in tablet form.

Sometimes erythema nodosum of the extremities manifests itself in women during the period of bearing a child, when it is contraindicated to take most of the pharmacological preparations and carry out some procedures. Treatment of pregnant women is carried out under the strict supervision of the attending dermatologist.

With timely treatment and well-chosen therapy, most cases of nodular erythema of the legs have a positive outcome of treatment.

For the treatment of erythema, the doctor will prescribe a complex of drugs

Traditional medicine against erythema nodosum

Alternative methods of treating erythema can speed up the healing process when properly combined with drugs and procedures of official medicine. From generation to generation, recipes for ointments, lotions, baths, compresses and herbal preparations are passed on:

• arnica flowers;
• nettle leaves;
• elderberries;
• red rowan;
• hawthorn;
• rose hips;
• immortelle color.

However, despite the positive effect of folk recipes, do not prescribe herbal medicine yourself. Please consult with your physician first. Sometimes the combination of pharmacological preparations with certain herbs gives unexpected results.

Take care of yourself and be healthy!

Skin rashes can be quite diverse in appearance. Some of them are harmless. Others signal a serious pathology in the body.

One of the easily recognizable ailments is erythema nodosum on the legs. Is this rash considered harmless or is it fraught with a serious pathology? The answer to this question lies in the causes of the disease.

General information

Erythema nodosum (photos showing the visual manifestation of the disease are below) - this is also adipose tissue. As a result, red nodules form on the surface. Their size can vary from the diameter of a cherry to the corresponding parameters of an orange. This phenomenon can be a symptom of various ailments. But often the true nature of the disease cannot be established. Therefore, erythema nodosum on the legs is considered in most cases as an independent disease.

Characteristics of the disease

Rashes on the surface of the skin are nodules of red color. They are quite painful. Even a slight touch is fraught with increased discomfort. It clearly demonstrates how erythema nodosum manifests itself, photo. As a rule, rashes rise slightly above the surface of the skin.

Nodules are localized mainly on the anterior surface of the legs, on the knees, and thighs. Rarely, rashes can occur on the hands, face, or neck.

The initial stage is characterized by bright red rashes. The further course of the disease is characterized by a change in the shade of neoplasms. The nodules acquire a purple color, which subsequently changes to brown.

As a rule, rashes remain on the surface of the skin for 5 to 10 days. Further, over the course of 3-6 weeks, the nodules gradually disappear.

Causes of the disease

As noted above, the source of the disease is not always possible to accurately establish. The main reasons why erythema nodosum occurs on the legs (for a photo of the characteristic manifestations, see the article) include tuberculous intoxication and

Sometimes an ailment is the initial symptom characteristic of the following diseases:

• fungal or bacterial infection;
• tuberculosis;
• inflammatory bowel processes;
• syphilis;
• cancer (very rare);
• sarcoidosis;
• Behçet's disease.

Often, the disease develops as a result of a reaction to the following groups of drugs:

• antibiotics;
• sulfones;
• sulfonamides;
• oral contraceptives.

Several factors are known to contribute to the development of the disease. These include:

• prolonged exposure to cold on the body;
• malfunctions of the endocrine system;
• hypovitaminosis and P);
• congestion in the limbs.

Symptoms

The most characteristic symptom of the disease are nodules. Initially, these seals are hard, flat, and feel hot to the touch. Sometimes accompanied by other signs of erythema nodosum. Symptoms may be as follows:

• general malaise;
• redness;
• joint pain;
• swelling of the legs;
• skin irritation.

Forms

There are two varieties of this disease:

- Acute erythema nodosum. This form is often accompanied by a strong increase in temperature. It is characterized by the presence of pain in the joints, muscles. Such rashes are characteristic of a disease that manifests itself in childhood. Sometimes the onset of the disease is the body's reaction to tuberculosis.

- Chronic This is a migratory form. It has a long subacute course with frequent relapses. Nodes have somewhat fuzzy borders. This form is found mainly in elderly and middle-aged women who have vascular or allergic ailments. Another prerequisite for the development of the disease is the presence of a chronic infection in the body.

Features of the disease in children

The disease is more common in girls who have reached the age of six. Rashes on the surface of the skin occur, as a rule, in cold weather. Symptoms of the disease appear on the sixth day.

Erythema nodosum in children is characterized by general malaise, whims. There is pain in the joints and in the abdomen. Hot, rather painful knots appear on the body.

Often the disease is combined with damage to the joints. In this case, the latter swell, redness, pain during movement appears. Inflammation in the joints disappears after a few days, but the pain persists for some time.

Erythema nodosum on the legs is treated with anti-inflammatory drugs. Often prescribed drugs such as Aspirin, Indomethacin, Brufen. Local apply on the affected areas. For them, heparin ointment, ichthyol solution are used. It is very important to notify the doctor about the child's illness. It should be remembered that self-treatment of the disease is quite dangerous.

Features of the treatment of pregnant women

The disease does not affect the fetus at all. However, erythema nodosum can be dangerous for a pregnant woman. The consequences of the disease sometimes manifest themselves in the form of complications on the heart.

If there are no exacerbations, the patient is prescribed local treatment. The affected areas are lubricated with the Indovazin Ointment. Inside take the drug "Kurantil". In small doses, the drug "Paracetamol" is prescribed. To reduce inflammation, the minimum dosage of Aspirin is recommended. The treatment includes Deep Relief ointment. The drug "Diclofenac" is prescribed in injections.

An important condition for treatment during pregnancy is the full observance of the correct regimen of rest and work. It is necessary to minimize the load on the lower extremities, but it cannot be completely excluded, because the vessels of the extremities must constantly be in good shape.

Treatment

A patient who turns to a doctor with unpleasant symptoms will be prescribed an X-ray examination of the lungs. This analysis will make it possible to exclude sarcoidosis and tuberculosis. A smear is taken for the presence of streptococcus. To exclude various infections, all kinds of blood tests are carried out.

How to treat erythema nodosum? Initially, you should get rid of negative thoughts and restore peace of mind. After all, they are the source of destruction of the whole organism. It is very important to eat right and lead a healthy lifestyle. It is recommended to cleanse the body of toxins. Particular attention should be paid to the intestines and liver. You can periodically starve or apply one of the weight loss diets. The most recommended are the following: vegetable, berry, buckwheat, kefir, fruit.

As a rule, for the treatment of an ailment, the doctor prescribes the following:

• antipyretic drugs;
• non-steroidal anti-inflammatory drugs ("Nimesil", "Indomethacin", "Ibuprofen");
• antibiotics (if an infectious process is detected);
• vitamins C, P;
• hormones (in case of an allergic process);
• autohemotherapy;
• heparin ointment;
• plasmapheresis;
• compresses;
• wraps.

Treatment with folk remedies

Many amazing recipes can be gleaned from healers. Traditional medicine will tell you many ways to get rid of such an ailment as erythema nodosum. Treatment with folk remedies is an auxiliary therapy. It should be combined with medication. In this case, the results will be much better.

Folk recipes:

• Chop the arnica flowers. Pour boiling water (200 ml) in a thermos. Leave the infusion all night. In the morning, the remedy should be filtered. Throughout the day, the infusion is taken in 1 tsp. at least five times.
• Choleretic agents have an excellent effect. They are made from berries and medicinal herbs. Melissa, lingonberry leaves, immortelle, birch, yarrow and mint, taken in equal parts, are brewed as follows: 1 tbsp. a spoonful of this collection for 0.5 liters of boiling water. 15 minutes before meals, drink a third of a glass of medicinal infusion.
• To prepare an anti-allergic agent, you will need bittersweet nightshade, succession, knotweed. All ingredients are taken in equal proportions. Mix ingredients thoroughly. To make a decoction, you need 1 tsp. collection. It is poured with one glass of boiling water. The solution should be held for two minutes on low heat. Within an hour, the remedy should be infused. Healing decoction is used three times a day. It is advisable to take it before meals.

• To prepare an effective tincture, you will need red elderberries. Ten grams of this component is poured with vodka. The last thing you need to take is 0.5 liters. It is recommended to insist the mixture for 40 days. After this period, the drug is ready. It should be taken once before bed. The dosage is calculated based on the weight of the patient. A patient with a body weight not exceeding 70 kg should take 20 drops of the drug. If the weight exceeds the indicated one, it is recommended to increase the dose to 30 drops. This tincture is advised to seize. For such purposes, black bread grated with garlic or poured with sunflower oil is suitable. The course of taking this remedy should last 1 month. For the next 30 days, you should take a break, and then resume the course of treatment again.
• In the fight against the disease, baths have proven themselves. For them you will need: willow and walnut bark, black elderberry and linden flowers, raspberry sprigs, nightshade grass. If it is not possible to find all the above components, it does not matter. Use the ingredients you can get. Grind them carefully. Pour boiling water over one tablespoon of the prepared collection (1 liter). Leave the resulting mixture for 15 minutes, then pour the infusion into the bath. After stirring the water, lie down in it. The duration of the procedure is a quarter of an hour.

Disease prognosis

If the disease is classified as independent, then it does not pose a threat to the body. At the same time, it is very important to carry out the therapy of all concomitant ailments in a timely manner, since they can be fraught with danger.

Another important nuance is the timely treatment of the disease. Running erythema nodosum is fraught with rather unpleasant complications. The consequences can be quite unpleasant. One of them is the transition of the disease into a chronic form.

Conclusion

Erythema nodosum on the legs is a fairly common ailment. Its development, as a rule, causes sensitization of the vessels of the subcutaneous tissue. Often, pathology in the body is caused by an infection or non-acceptance of certain medications. Sometimes these rashes can act as symptoms of a completely different ailment.

In which the vessels are affected locally, mainly in the lower extremities. Persons of both sexes and all ages suffer from this disease, however, most of the patients are aged 20-30 years, and there is only one man for 3-6 sick women. From this article you will learn what erythema nodosum is, why and how it develops, what are the clinical manifestations, as well as the causes, principles of diagnosis and treatment of this pathology. So, let's begin.

What is erythema nodosum

Erythema nodosum is a systemic disease of the connective tissue with lesions of the skin and subcutaneous adipose tissue, the most typical manifestation of which is painful on palpation, moderately dense nodules 0.5-5 cm or more in diameter.

In about a third of patients, erythema nodosum occurs as an independent disease - in this case it is called primary. However, more often it develops against the background of some background pathology and is called secondary.

Causes and mechanisms of development of erythema nodosum

The etiology of primary nodular erythema is not fully understood. Experts believe that genetic predisposition plays a role in the occurrence of this disease. In the vast majority of cases, erythema nodosum is a non-specific immune-inflammatory syndrome, which can be provoked by many infectious and non-infectious factors. The main ones are presented below:

1. Non-infectious factors:

• the most common is sarcoidosis;
• inflammatory bowel diseases, in particular regional enteritis and;
• Behçet's syndrome;
• benign and;
• lymphogranulomatosis (Hodgkin's disease);
• taking certain medications (antibiotics, sulfonamides, iodides, salicylates, oral hormonal contraceptives);
• pregnancy.

1. Infectious factors:

• streptococcal diseases are also one of the most common causes of erythema nodosum;
• - similar to diseases caused by streptococci;
• psittacosis;
• histoplasmosis;
• coccidio- and blastomycosis;
• trichophytosis;
• cat scratch disease
• inguinal lymphogranulomatosis;
• gonorrhea and others.

The mechanisms of development of erythema nodosum are also not fully understood to date. It is assumed that infectious agents and chemicals contained in drugs create a certain antigenic background in the body, which will not be noticed, and a genetically predisposed one will give an immune response: a series of biochemical reactions will start in it and antibodies will begin to be produced. Often this pathology manifests itself during pregnancy. Probably, the changed hormonal background also initiates the process of antibody formation, and perhaps this moment is due to the fact that during this period the woman's body is significantly weakened and loses the ability to adequately resist negative factors.

Pathological changes in erythema nodosum

As mentioned above, erythema nodosum is a non-specific inflammatory process. First of all, small blood vessels of the lower extremities and lobules of adipose tissue, along with interlobular septa, located on the border of the dermis and subcutaneous adipose tissue, are affected.

In the first 0.5-2 days of the disease, inflammation of the wall of the veins, less often of the arteries, is microscopically determined. Endothelial cells and other layers of the vascular wall swell, inflammatory infiltrates (seals) appear in them, consisting of lymphocytes and eosinophils. Hemorrhages occur in the surrounding tissues.

A week after the first signs of the disease appear, chronic changes begin to develop. In the composition of the cellular infiltrate, in addition to lymphocytes, histiocytes and giant cells are determined. Vascular obstruction develops, fatty lobules are infiltrated by histiocytes, lymphocytes, giant and plasma cells. Sometimes microabscesses form.

In the future, the infiltrates of the walls of blood vessels and fatty lobules described above are converted into connective tissue.

The upper layer of the dermis and the epidermis are usually not involved in the pathological process.

Clinical features of erythema nodosum

Depending on the severity of symptoms, the characteristics of the course and the duration of the onset of the disease, there are 3 types of erythema nodosum:

1. Acute erythema nodosum. The pathognomonic symptom of this type of disease is the nodes located, as a rule, symmetrically on the anterior surfaces of the legs or in the area of ​​the knee and ankle joints, less often on the feet and forearms. Sometimes the rashes are not multiple, but are single. The nodes have sizes from 0.5 to 5 cm, are dense to the touch, painful, slightly rise above the level of the skin, their borders are indistinct due to some swelling of the surrounding tissues. The skin over the nodes is smooth, at first reddish-pink, then cyanotic, and at the stage of resolution of the process - greenish-yellow. First, a small knot appears, which grows rapidly and, reaching a maximum size, stops growing. Sometimes the nodes are not only painful on palpation, but also spontaneously hurt, and the pain syndrome can be of varying intensity, from mild to severe. In 3-6 weeks after the appearance, the nodes disappear, leaving no cicatricial or atrophic changes, only temporarily peeling and increased skin pigmentation can be determined in their place. Usually do not recur. not typical. Often, in addition to nodes, patients complain of an increase in body temperature to febrile (38-39 ° C) values, general weakness, flying pains in muscles and joints. In the blood, an increase in the level of leukocytes, ESR and other changes characteristic of the inflammatory process are determined.
2. Migrating nodular erythema. It proceeds without pronounced clinical manifestations, that is, subacutely. The patient feels weakness, pain in the joints of moderate intensity, the body temperature rises to subfebrile values ​​​​(37-38 ° C), the person is shivering. Then a knot appears on the anterolateral surface of the lower leg. It is flat, dense, clearly delimited from the surrounding tissues. The skin above the knot is bluish-red. As the disease progresses, the inflammatory infiltrate migrates, resulting in the formation of the so-called plaque, which has the form of a ring with a bright peripheral zone and a pale-colored depression in the center. Later, a few more small knots may appear on both legs. After 0.5-2 months, the nodes regress.
3. Chronic erythema nodosum. It develops, as a rule, in women over the age of 40, suffering from chronic infectious diseases or having. Symptoms of intoxication are extremely weak or absent. The location of the nodes is typical, however, they are almost invisible externally: they do not rise above the skin and do not change its color. Periodically, the process worsens, the symptoms of the disease become more pronounced. This is usually noted in the autumn-spring period, which is most likely due to the greater frequency of streptococcal infection at this time.

The articular syndrome in erythema nodosum is characterized by symmetrical involvement of large joints in the pathological process: they are swollen, the skin above them is hyperemic, hot to the touch. Sometimes the small joints of the feet and hands are also affected. As the skin nodules resolve, the inflammation of the joints also disappears.

Diagnosis of erythema nodosum

Based on the patient's complaints, the history of the disease and life, taking into account the data of an objective examination, the doctor will make a preliminary diagnosis of "erythema nodosum". To confirm or refute it, it will be necessary to conduct a number of additional laboratory and instrumental studies, namely:

1. A clinical blood test (it will determine the signs of an inflammatory process in the body: neutrophilic leukocytosis, increased to 30-40 mm / h ESR, that is, the erythrocyte sedimentation rate.
2. A blood test for rheumatic tests (it will detect rheumatoid factor).
3. Bakposev from the nasopharynx (performed in order to search for streptococcal infection in it).
4. Tuberculin diagnostics with 2 TO of tuberculin (performed in case of suspected tuberculosis).
5. Bakposev feces (with suspicion of yersiniosis).
6. Biopsy of nodular formations followed by microscopic examination of the material taken (with erythema nodosum, inflammatory changes are found in the walls of small veins and arteries, as well as in the area of ​​interlobular septa in the areas of transition of the dermis into subcutaneous fatty tissue).
7. Rhino- and pharyngoscopy (in order to search for chronic foci of infection).
8. X-ray of the chest organs.
9. Computed tomography of the chest.
10. Ultrasound of the veins and rheovasography of the lower extremities (to determine their patency and the severity of inflammation).
11. Consultations of specialists of related specialties: infectious disease specialist, otorhinolaryngologist, pulmonologist, phlebologist and others.

Of course, all the above studies may not be assigned to the same patient: their volume is determined individually, depending on the clinical picture of the disease and other data.

Differential diagnosis of erythema nodosum

The main diseases with which differential diagnosis of erythema nodosum should be carried out are:

1. . Painful seals on the skin in this disease resemble those in erythema nodosum, but they are located exclusively along the course of the veins and look like tortuous strands. The limb is edematous, the patient complains of pain in the muscles. The general condition of the patient, as a rule, does not suffer; if the thrombus becomes infected, the patient notes weakness, fever, sweating and other manifestations of the intoxication syndrome.
2. Erythema Bazin (second name - indurative tuberculosis). Rashes in this disease are localized on the back of the leg. The nodes develop slowly, they are not characterized by signs of inflammation, there is also no noticeable delimitation from the surrounding tissues. The skin over the nodes is red-cyanotic, but the change in its color with the course of the disease is not typical. Often, the nodes ulcerate, leaving behind a scar. As a rule, women suffering from tuberculosis are ill.
3. Christian-Weber disease. This disease is also characterized by the formation of subcutaneous nodes, however, they are localized in the subcutaneous fatty tissue of the forearms, trunk and thighs, small in size, moderately painful. The skin over the nodes is slightly hyperemic or not changed at all. Leave behind areas of cellular atrophy.
4. (). This is an acute infectious disease, the causative agent of which is group A β-hemolytic streptococcus. Erysipelas debuts acutely with a rise in temperature to febrile values, severe weakness and other symptoms of general intoxication. After some time, there is a burning sensation, pain and a feeling of tension in the affected area of ​​the skin, after that - swelling and hyperemia. The area of ​​redness is clearly delimited from the adjacent tissues, its edges are uneven. On the periphery, the seal is determined. The area of ​​inflammation rises slightly above the level of the skin, hot to the touch. Blisters with serous or hemorrhagic contents, as well as hemorrhages, may form. A radical difference from erythema nodosum is inflammation of the lymphatic vessels and regional ones with erysipelas.

Treatment of erythema nodosum

If it was possible to determine the disease against which this nonspecific immunoinflammatory syndrome developed, then the main direction of treatment is to eliminate it. With an infectious etiology of the underlying disease, antibacterial, antifungal and agents are used for the purpose of treatment.

In the case of primary erythema nodosum, the patient may be prescribed drugs of the following groups:

• (Movalis, Nimesulide, Celecoxib, Diclofenac);
• (Prednisolone, Methylprednisolone) are used in case of insufficient effectiveness of NSAIDs;
• aminoquinoline drugs (Delagil, Plaquenil) - they are prescribed for often recurrent or protracted forms of the disease;
• antihistamines (Suprastin, Loratadin, Cetirizine).

The rapid regression of the symptoms of the disease is facilitated by the use of extracorporeal methods - plasmapheresis, hemosorption - and laser blood irradiation.

Local treatment can also be carried out: applying anti-inflammatory, in particular hormonal ointments, compresses with dimexide to the skin.

Physiotherapy also gives a positive result in the treatment of erythema nodosum. As a rule, magnetic and laser therapy, ultraviolet radiation in erythemal doses, phonophoresis with hydrocortisone on the affected area are used.

At home, it is undesirable to treat this disease, since the drugs used to treat it have a number of side effects and, if used ineptly, can damage the patient's health.

The criteria for the effectiveness of the therapy are the regression of clinical signs of the disease and the reduction or absolute disappearance of pathomorphological signs of inflammation of the vessels of the subcutaneous tissue.

Consequences and prognosis of erythema nodosum

By itself, this disease is not dangerous, however, as has been repeatedly said above, it is often a companion of all sorts of other pathologies. Often it appears even when the underlying disease has not had time to manifest itself, which means it has not been diagnosed. A timely visit to the doctor about erythema nodosum and a complete examination in connection with this make it possible to diagnose the early stages of a particular underlying disease in time, which means preventing a number of possible complications of it.