What is erythema nodosum: causes and treatment methods. Erythema nodosum on legs

Erythema nodosum (synonym: erythema nodosum) is a syndrome based on allergic or granulomatous inflammation subcutaneous tissue. The disease belongs to the group of vasculitis. Erythema nodosum is a polyetiological form of deep vasculitis.

Erythema nodosum is an independent form of panniculitis, which is characterized by the formation of red or purple palpable subcutaneous nodes on the legs and sometimes in other areas. Often develops when there is systemic disease, especially when streptococcal infections, sarcoidosis and tuberculosis.

ICD-10 code

L52 Erythema nodosum

What causes erythema nodosum?

Erythema nodosum most often develops in women between 20 and 30 years of age, but can also occur at any age. The etiology is unknown, but a connection with other diseases is suspected: streptococcal infection (especially in children), sarcoidosis and tuberculosis. Other possible triggers are bacterial infections(Yersinia, Salmonella, mycoplasma, chlamydia, leprosy, lymphogranuloma venereum), fungal infections(coccidioidosis, blastomycosis, histoplasmosis) and viral infections (Epstein-Barr, hepatitis B); use of medications (sulfonamides, iodides, bromides, oral contraception); inflammatory diseases intestines; malignant neoplasms, pregnancy. 1/3 of cases are idiopathic.

The cause of erythema nodosum is primary tuberculosis, leprosy, yersiniosis, lymphogranuloma venereum and other infections. The occurrence of the disease after taking drugs containing the sulfonamide group and contraceptives has been described. In half of the patients, the cause of the disease cannot be identified. In the pathogenesis of the disease, a hyperergic reaction of the body to infectious agents and drugs is noted. Develops in many acute and chronic, mainly infectious, diseases (angina, viral, yersinia infections, tuberculosis, leprosy, rheumatism, sarcoidosis, etc.), intolerance medicines(iodine, bromine, sulfonamides), some systemic lymphoproliferative diseases (leukemia, lymphogranulomatosis, etc.), malignant neoplasms internal organs(hypernephroid cancer).

Pathomorphology of erythema nodosum

The vessels of the subcutaneous tissue are mainly affected - small arteries, arterioles, venules and capillaries. In the dermis, the changes are less pronounced and appear only as small perivascular infiltrates. In fresh lesions, clusters of lymphocytes and different quantity neutrophilic granules. In places one can see more massive infiltrates of a lymphohistiocytic nature with an admixture of eosinophilic granulocytes. Capillaritis, destructive-proliferative arteriolitis and venulitis are noted. In larger vessels along with dystrophic changes endotheliums show infiltration by inflammatory elements, and therefore some authors believe that the basis of skin damage in this disease is vasculitis with primary changes in the vessels. In old elements, neutrophilic granulocytes are usually absent; granulation changes with the presence of cells predominate foreign bodies. Characteristic of this disease is the presence of small histiocytic nodules located radially around the central fissure. Sometimes these nodules are permeated with neutrophilic granulocytes.

The histogenesis of erythema nodosum is poorly understood. Despite the undoubted association of the disease with a wide variety of infectious, inflammatory and neoplastic processes, in many cases it is not possible to identify etiological factor. In some patients, circulating substances are found in the blood immune complexes, increased content of IgG, IgM and C3 component of complement.

Histopathology

Histologically, the substrate of erythema nodosum is a perivascular infiltrate consisting of lymphocytes, neutrophils, a large number of histiocytes, endothelial proliferation of the saphenous veins, capillary arterioles, swelling of the dermis due to increased permeability of the vascular membrane, acute dermohypodermatitis nodosum.

Erythema nodosum is characterized by the formation of erythematous soft plaques and nodules, which is accompanied by fever, general malaise and arthralgia.

Erythema nodosum type rashes are one of the main manifestations of Sweet's syndrome (acute febrile neutrophilic dermatosis), characterized, in addition, by high fever, neutrophilic leukocytosis, arthralgia, and the presence of other polymorphic rashes (vesiculopustular, bullous, multiforme type). exudative erythema, erythematous, plaque, ulcerative), located mainly on the face, neck, extremities, in the development of which immunocomplex vasculitis is considered important. There are acute and chronic erythema nodosum. Acute erythema nodosum usually occurs against the background of fever, malaise, and is manifested by rapidly developing, often multiple, rather large dermohypodermal nodules of oval outline, hemispherical in shape, slightly raised above the surrounding skin, painful on palpation. Their boundaries are unclear. The predominant localization is the anterior surface of the legs, knees and ankle joints, the rashes can be widespread. The skin over the nodes is first bright pink, then the color becomes bluish. A characteristic change in color over several days is similar to the “blooming” of a bruise - from bright red to yellow-green. Resorption of the nodes occurs within 2-3 weeks, less often later; relapses are possible.

An acute process is characterized by nodular, dense, painful on palpation foci of a hemispherical or flattened shape. Rashes often appear in waves, localized symmetrically on the extensor surfaces of the legs, less often on the thighs, buttocks, and forearms. A few days after their appearance, the lesions begin to regress with a characteristic change from pinkish-livid-red color to liquid-brownish and greenish-yellow, like a “bruise bloom.” Evolution of an element - 1-2 weeks. The nodes do not merge with each other and do not ulcerate. An outbreak of rashes is usually observed in spring and autumn. They are accompanied general phenomena: fever, chills, joint pain. Erythema nodosum can become chronically migratory (erythema nodosum migrans of Böfverstedt).

Treatment of erythema nodosum

Erythema nodosum almost always resolves spontaneously. Treatment includes bed rest, limb elevation, cool compresses, and nonsteroidal anti-inflammatory drugs. Potassium iodide 300-500 mg orally 3 times a day is used to reduce inflammation. Systemic glucocorticoids are effective but should be used as a last resort because they may worsen the underlying disease. If the underlying disease is identified, treatment should begin.

Antibiotics are prescribed (erythromycin, doxycycline, penicillin, ceporin, kefzol); desensitizing agents; salicylates (aspirin, askofen); vitamins C, B, PP, ascorutin, rutin, flugalin, syncumar, delagil, plaquenil; angioprotectors - complamin, aescusan, diprofen, trental; anticoagulants (heparin); non-steroidal anti-inflammatory drugs (indomethacin 0.05 g 3 times a day, voltaren 0.05 g 3 times a day, medintol 0.075 g 3 times a day - optional); xanthinol nicotinate 0.15 g 3 times a day (teonicol 0.3 g 2 times a day); prednisolone 15-30 mg per day (in cases of insufficient effectiveness of therapy, with progression of the process). Sanitation of foci of infection is carried out. Locally prescribed dry heat, UHF, UV, compresses with 10% ichthyol solution.

Erythema nodosum- inflammation of the skin and underlying tissue (fat cells), resulting in the formation of red, painful nodules ranging in size from cherries to oranges. The disease can be a symptom of various diseases, but in about a third of cases the cause cannot be determined, and erythema nodosum is considered as an independent disease.

Skin rashes can vary greatly appearance. At the same time, rashes of the same type can be either completely safe or indicate the presence of a serious illness that requires immediate consultation with a doctor and active treatment. That is why remote consultations are extremely difficult, in which the probability of error is very high.

The situation is somewhat different when erythema nodosum. This disease is quite easily recognized based on the description: red, painful nodes under the skin, which usually disappear within 3-10 days. Recognize disease It’s not difficult, the problem is different: you need to understand whether the problem has some cause or arose on its own.

As a rule, the disease as an independent disease does not pose a serious threat. But it is extremely important to exclude other diseases that may be dangerous.

Symptoms of erythema nodosum

The skin lesions of erythema nodosum appear as red nodules or nodules (cherry to orange in size). They are painful, and even with a slight touch the pain usually intensifies. The nodules usually rise above the skin. The total number of nodules can reach 50 pieces.

The most common place for nodules to form is the front surface of the legs, knees and thighs. On outer surface on the hands, face and neck, rashes are less common and are usually smaller in size.

At the beginning of the disease, the nodules have a bright red color, which subsequently changes to purple and then to brown of various shades (as a bruise fades).
The rash usually lasts for 5-10 days. Then over the course of 3-6 weeks they gradually disappear.

The appearance of nodules is often preceded by respiratory infection(1-2 weeks earlier). Sometimes the rashes are accompanied by fever, general malaise, pain in the joints (usually the knees) and inflammation of the eyes (conjunctivitis).

Causes of erythema nodosum

Erythema nodosum can be an independent disease. In this case, it is not possible to determine its cause. The disease may be preceded by an acute respiratory infection or medication, but eliminating these causes does not stop the formation of nodules.

However, another situation is also possible (by the way, it occurs twice as often) - erythema nodosum is only one of the symptoms of another disease.

To the number similar reasons include the following.

• Reception of some medicines (oral contraceptives, sulfonamides, iodides and bromides.
• Infectious diseases (tuberculosis, streptococcal infections, yersiniosis, etc.).
• Autoimmune diseases ( systemic lupus erythematosus , rheumatoid arthritis and etc.).
• Chronic inflammatory bowel diseases (ulcerative colitis, Crohn's disease, etc.).
• Tumor diseases (including blood).
• Sarcoidosis.
• Risk factors for erythema nodosum

The risk of developing erythema nodosum is increased in the presence of predisposing diseases. Also in the group increased risk There are pregnant women, as well as women taking contraceptives.

Diagnosis of erythema nodosum

Based on questioning the patient and examining the rashes.

Additional research has two objectives:

• exclude the presence of another disease (which requires more active treatment);
• assess the activity of inflammation (erythrocyte sedimentation rate, C-reactive protein).

Volume additional research can be quite significant. Thus, if tuberculosis is suspected, the Mantoux test and X-ray examinations may be needed chest, sputum cultures (if available), etc. Special blood tests are often necessary to rule out infections. Specific approaches are also required in situations where autoimmune or tumor diseases are suspected.

Treatment of erythema nodosum

When erythema nodosum occurs for the first time, it is possible to independently use non-steroidal anti-inflammatory drugs to relieve symptoms. It is also recommended to keep your legs elevated (if possible), use elastic bandages and stockings. Compresses can also be used to treat erythema nodosum. The rash usually remains red and painful for up to 10 days. If rashes reoccur, you should consult a doctor to clarify the cause of erythema nodosum and select adequate treatment.

IN severe cases, with repeated episodes of rashes, the presence accompanying symptoms(fever, joint pain, etc.) may be prescribed glucocorticoids (hormonal drugs) as treatment.

Erythema nodosum (nodosa) is an allergic, inflammatory process in the subcutaneous fat layer. The affected areas appear as red-blue spots with compactions and feel hot to the touch. They are most often localized on the arms and legs, less often on the stomach, back and other parts of the body. According to statistics, erythema nodosum occurs several times more often in women than in men.

Erythema nodosum is characterized by red-blue spots

Types of erythema nodosum

A disease such as erythema nodosum has several varieties, depending on the form of the disease and progression:

• chronic erythema nodosum;
• acute erythema nodosum.

If acute form It has certain type course of the disease, chronic erythema nodosum is divided into subtypes:

• migratory erythema nodosum;
• superficial-infiltrative.

Erythema migrans

With migrating erythema, dense nodes appear with shapeless edges of a bluish-red color.

Erythema superficial-infiltrative

With superficial infiltrative erythema, the affected areas increase to large sizes, body temperature rises, and there is hyperemia at the site. Appears strong pain, joints swell. ESR increases in the blood.

Erythema can lead to fever and severe pain

What causes erythema nodosum? Causes

The causes of erythema nodosum can be very diverse. Most often, the disease appears under the influence of such factors:

1. The appearance of the described erythema may indicate that a disease such as tuberculosis is beginning or progressing in the body.
2. Also, with sarcoidosis and ulcerative colitis, erythema nodosum may appear.
3. Another cause of the disease may be infectious diseases(coccidioidomycosis, histoplasmosis, and yersiniosis).
4. In the same way, an inflammatory nodular process appears after taking certain medications. Because of them it will begin allergic reaction accompanied by erythema.
5. With streptococcal infections (tonsillitis, scarlet fever), there is a possibility of the appearance of affected areas of the skin.

Erythema nodosum symptoms

The appearance and development of erythema nodosum can be determined by physical factors illness:

Diagnosis of erythema nodosum

First of all, the doctor interviews the patient and analyzes the information received. After collecting anamnesis, the attending physician examines and palpates the skin.

To confirm the diagnosis, a biopsy is taken for histological examination of the tissue.

To exclude systemic diseases, the following is prescribed:

• swab from the throat and nose;
• X-rays of light;
• computed tomography of the chest;
• consultations with specialized specialists, such as: pulmonologist, otorhinolaryngologist and infectious disease specialist;
• bacterial culture of stool (if there is a suspicion of yersiniosis);
• if tuberculosis is suspected, tuberculin diagnostics are performed.

X-ray of the lungs is necessary for correct setting diagnosis

Acute erythema nodosum, features

In acute erythema nodosum, the lesions are located symmetrically on both legs or both forearms, in in rare cases located on other areas of the skin. There may be many affected areas or, conversely, a small number. The size of the nodule can be from 5 to 50 millimeters. On palpation, pain is noted in the lesions. The contour of the inflamed skin is shapeless and blurred. At the beginning of the disease, the node is small in size, but it quickly increases. After the compaction has reached its maximum size, the growth of the node stops.

After about a month, the nodes resolve, leaving pigmented areas of skin in their place and dark spots. Over time, no trace of erythema nodosum will remain. No relapse is observed.

There is no itching. A blood test determines increase in ESR, high level leukocytes, which indicates an inflammatory process in the human body.

After a month, the nodes resolve, leaving pigmented areas of skin and dark spots in their place.

Migratory form of erythema nodosum, features

Migratory erythema nodosum occurs with a subacute course. The patient experiences pain in the joints, general malaise, chills, and increased body temperature. The lesion that appears on the lower leg is flat and dense to the touch. The skin over the nodule has a bluish-red color. After a few weeks, a softening in the center can be felt at the site of the node. Then, several small nodules may appear symmetrically near the existing lesions.

Chronic erythema nodosum, features

More often, this type Erythema nodosum worries women over the age of 45 who have neoplasms in the pelvic organs. Intoxication symptoms most often do not appear. The nodes are located in the same places as in acute and migratory erythema. But unlike the above types, with chronic erythema, the color of the skin over the nodules does not change. With exacerbation, the symptoms of the disease become more pronounced.

Exacerbation most often occurs in autumn and spring, this is due to the fact that at this time the frequency of infections caused by streptococci increases.

Erythema nodosum affects large joints. There is swelling and hyperemia in the joint area. In rare cases, the joints of the hands and feet are affected. After the nodules begin to resolve, the joints are also restored.

Streptococcal infections cause exacerbation of the disease

Treatment of erythema nodosum

If the diagnosis of the disease due to which the autoimmune process has developed is correctly established, then treatment should be aimed at eliminating it.

If the disease appears due to infectious process in the body, the attending physician prescribes drugs with antifungal, antibacterial, and antiviral effects.

For primary erythema, the patient is prescribed:

• antiallergic drugs (Loratadine, Suprastin, Edem);
• corticosteroid drugs (Prednisolone) to improve the effect of NSAIDs;
• non-steroidal anti-inflammatory drugs (Diclofenac, Movalis).

In addition to the listed medications, it is necessary to apply ointments and compresses with dimexide solution to the affected areas of the skin.

Physiotherapy is also prescribed, which is effective for erythema nodosum. They use ultraviolet irradiation in small doses, laser therapy and phonophoresis with hydrocortisone.

Laser therapy is effective for erythema nodosum

Erythema nodosum during pregnancy

If erythema nodosum appears during pregnancy, then it is necessary to inform the gynecologist with whom the pregnant woman is registered. Next, he will refer the pregnant woman to specialized specialists, and they will carefully conduct a diagnosis to identify the reasons for which this disease manifested itself. The disease cannot be left to chance, since identifying and treating the disease is mandatory measure. After all, in the body there may be serious illness, such as tuberculosis or gastrointestinal diseases. If the reason is confirmed, the treatment will be much more difficult.

Erythema nodosum during pregnancy does not have any direct effect negative impact for the fruit The disease will affect the health of the expectant mother.

Because there is a suspicion that erythema will cause cardiovascular disease vascular system. In addition, stress may arise nervous soil which will have a bad impact on nervous system mother and child. It is not uncommon for foci of erythema to resolve by the beginning of the third trimester of pregnancy.

If erythema nodosum appears, you must be constantly monitored by a doctor.

Treatment of erythema nodosum during treatment

If the erythema is not complicated by anything, then it is necessary to carry out local treatment using the small list of medications that are allowed during pregnancy. These include:

• paracetamol (tablets);
• aspirin tablets orally and diclofenac injections to relieve the inflammatory process;
• indovazine ointment for lubricating affected areas of the skin.

One more important criterion When treating such an illness, it is necessary to adhere to a sleep and rest regime. It is also necessary to minimize the load on the vessels of the lower extremities. To strengthen blood vessels, a period of alternation is prescribed: sleep, rest, walking fresh air And bed rest. The method of treating erythema nodosum must be determined by a rheumatologist and gynecologist with whom the pregnant woman is registered. After all, if the treatment is incorrectly prescribed and carried out incorrectly, then the erythema can become chronic. And in this case, exacerbations of the disease cannot be avoided in the spring and autumn period, as well as with decreased immunity, and during subsequent pregnancies.

Which doctor should I consult with this illness?

If compacted nodules appear under your skin, and you cannot determine what it is, what kind of illness it is, then it is not recommended to delay going to the doctor. After all, in this way you can overlook a life-threatening disease. Then the treatment will be much more difficult. Therefore, at the first symptoms of erythema, it is necessary to visit: an oncologist, an infectious disease specialist, a gynecologist, a gastroenterologist, as well as a venereologist.

Erythema nodosum is a lesion of the skin and subcutaneous vessels, usually of an allergic nature. In this case, dense and very painful nodular formations appear. This often happens on lower limbs.

Let's consider why pathology appears on the legs, what are its symptoms, treatment and methods of prevention.

Causes

There are studies that prove that erythema is nothing more than a variant of the course of vasculitis of an allergic nature. Many patients are interested in what it is. With this disease, local vascular damage occurs. As a rule, such damage occurs on the legs.

This diagnosis is given to people of any kind. age category. The prevalence of this disease before the onset of puberty is almost the same in males and females. After puberty The disease is more common in women than in men.

Acute and chronic forms develop for the following reasons:

1. Infectious pathologies. As a rule, these are tonsillitis, scarlet fever, pharyngitis and others.
2. Joint damage.
3. Tuberculosis.
4. Acute lesions worms.
5. Lymphogranulomatosis inguinal.
6. Impact of certain medications.
7. Behçet's disease.
8. Ulcerative colitis of various etiologies.
9. Inflammatory pathologies in the intestines (primarily Crohn's syndrome).
10. A specific reaction of the whole organism to the use of oral contraceptives.
11. Oncological diseases(especially often such formation appears on the legs with hypernephroma).
12. Pregnancy.

In addition, there are cases when this disease occurs in children. As a rule, this happens to them after previous sore throat. More likely the occurrence of this pathology in the presence of unfavorable family heredity.

The greatest predisposition to this disease occurs in those who suffer varicose veins veins of the lower extremities, atherosclerosis (especially if the pathology is diagnosed in the lower extremities), as well as bronchial asthma, atopic dermatitis and other pathologies such as tonsillitis, sinusitis and others.

The main manifestations of pathology

Typical symptoms of the disease are the appearance of dense nodes under the skin. Their diameter can vary - from 5 mm to 5 cm. The skin above such nodes is usually smooth and has a reddish tint.

These elements usually rise above the skin level, the contours of the nodes are unclear, since the boundaries of the surrounding tissues healthy skin blurred. As a rule, nodes above the skin, having reached a certain size, stop increasing in the future.

Is there pain with this disease? Yes, and it can have different intensity and severity. Often pain syndrome happens when the nodes are palpated, but there are often cases when it appears spontaneously, without palpation. Usually such formations do not itch.

After a few days, the resulting nodes begin to resolve. In this case, their disintegration is not observed, but the skin above them still changes, the patient notes a change in color. The same processes occur as during the development of a regular bruise.. Thus, the color of the skin changes from brown to bluish, and then becomes green and, finally, yellowish.

The typical location of the nodes is on the front of the lower leg. Usually such nodes are located symmetrically. It happens that they appear in a one-sided location. It happens that the affected area increases, then the nodes are localized on the hips, gluteal region, forearm, etc.

Acute and chronic course of the disease

The acute version of the disease is more common. This process is accompanied by loss of appetite, elevated temperature(sometimes fever), malaise. Often in acute period there is a chill. In the vast majority of cases, patients complain of pain in the joints. It increases in the morning, and then stiffness of movement is noted.

Objectively, signs of inflammation in the joint are observed: the temperature rises in the area around it, and so-called effusion accumulates inside it. Moreover, large joints are symmetrically affected.

Within a few weeks, the so-called resolution of erythema occurs. However, after this, increased skin pigmentation is temporarily observed in previously affected areas. This phenomenon persists for some months.

The consequences of the disease are usually favorable. If you follow all the doctor’s recommendations, complete recovery occurs.

Classification of erythema

As already noted, erythema can be acute or chronic. The chronic type of the disease has two types:

• migrating (with this form, dense nodes have blurred boundaries, they are usually bluish or red);
• superficial nodular (the nodes in this disease are very large, and the appearance and development of such objects is accompanied by skin rashes, fever, pain and an increase in the erythrocyte sedimentation rate).

This is the most common classification of the disease and is used most often. Idiopathic erythema is spoken of when its cause cannot be determined.

Features of erythema during pregnancy

Data medical research they say that during pregnancy, erythema occurs in a maximum of 6% of cases. Most often, a biopsy of the node is prescribed to diagnose the disease in a pregnant woman.

The doctor, of course, will be helped in his work by a thorough analysis of the medical history. And here x-ray examination This is not recommended (in any case, the effect of radiation on the fetus must be taken into account). Typically, when X-rays are taken, women's abdomen is protected with lead.

The reasons for its occurrence in pregnant women are not entirely clear. It is likely that its development is determined by factors associated with impaired activity immune system due to hormonal changes.

IN Lately The incidence of erythema nodosum increases in pregnant women undergoing reproductive treatment.

The determining role of female sex hormones in the development of erythema nodosum in women has been proven. During pregnancy, their ratio changes, which causes symptoms of erythema.

Some anatomical features The vascular system of women also influences the occurrence of foci of erythema. Due to the fact that the network of arteries on the anterior surfaces of the legs is relatively small, foci of erythema appear in these areas of the body.

During pregnancy, it will be enough for a woman to wear elastic bandage and compliance with bed rest. Many drugs are contraindicated in pregnant women, so drug treatment erythematous nodes are limited. Most often such women are prescribed potassium iodide and its drugs. The duration of therapy with such drugs is up to 4 weeks.

The use of non-steroidal anti-inflammatory drugs (NSAIDs) during pregnancy is limited: in the first trimester they are completely contraindicated, and thereafter they are prescribed with extreme caution when the benefits of treatment are much greater than the risks of use.

It has been proven that the use of NSAIDs in the third trimester can cause heart defects in the baby. And since the disease in most cases is self-regressive, bed rest will be enough.

Features of disease diagnosis

Very important differential diagnosis, since it allows you to more accurately determine the presence of erythema. It makes it possible to identify the causes of erythema and outline possible ways treatment. The diagnosis can be made only after conducting a set of necessary studies.

There are the following methods for diagnosing the disease:

1. Culture for bacteria from the nasopharynx area. Usually it allows you to determine whether the patient has streptococci.
2. Diagnostics are carried out to exclude the presence of tuberculosis infection in a person.
3. Blood test for rheumatoid factors allow you to establish or exclude the presence of rheumatic joint damage.
4. A node biopsy is usually prescribed in difficult situations that make diagnosis difficult.
5. Consultation with specialized specialists such as a pulmonologist, infectious disease specialist, phlebologist, vascular surgeon and so on.
6. Rhinoscopy.
7. Pharyngoscopy.
8. Ultrasound of the veins of the lower extremities.
9. X-ray examination lungs.

Such a thorough diagnosis allows you to determine treatment in adults and children. Don't give up on everyone necessary examinations, since recovery depends on them.

Treatment options

The main principles of treatment for this disease are as follows:

1. Sanitation of chronic infectious foci.
2. Antibiotic treatment (carried out only after preliminary general diagnosis).
3. Prescription of non-steroidal anti-inflammatory drugs. The most commonly used are Nimesil or Indomethacin, Brufen.
4. Hormonal drugs. These include, for example, Prednisolone.
5. Hemocorrection.
6. Laser therapy.
7. Phonophoresis.
8. Treatment of affected joints (with hydrocortisone).

Such a disease is unlikely to allow a person to perform any physical types work. The disease is usually treated in a hospital setting. Bed or semi-bed rest is recommended.

Many patients are interested in whether sports are allowed during or after recovery. After such an illness, you must exclude any sports activities and training for a period of one month.

Drug treatment for such a disease is quite serious, because the list of drugs prescribed for erythema is significant. The patient cannot prescribe such medications to himself; he must consult a doctor. Let us note the most common medications, in addition to those listed above:

• desensitizing drugs (taken if the body has allergies);
• drugs acetylsalicylic acid;
• vitamin preparations(especially groups B, C);
• Rutin, Askorutin;
• anticoagulants (in particular, heparic acid).

Treatment using traditional methods

Treatment may sometimes be practiced folk remedies. First of all, this treatment involves a certain diet. You need to add grains, beans, and greens to your diet. To combat edema, diuretics are prescribed.

It should be noted that they are not the only means treatment of pathology, but only complement what the doctor prescribed. Of course, if you practice this type of therapy, it can only alleviate the condition, and not cure the person completely.

Prevention of erythema

Prevention of the disease, as a rule, comes down to timely consultation with a doctor if certain health problems arise. If there are foci of infection, their complete sanitation is necessary. It's important to lead healthy image life, alternate physical exercise with rest.

This pathology does not pose a health hazard, because the nodes tend to resolve. But still, it must be treated in order to prevent the development of a chronic form. People prone to the formation of erythema nodosum need to be attentive to their health and promptly contact specialists when the first symptoms of trouble appear.

Today we will talk about a serious common disease that everyone should know about - erythema nodosum of the lower extremities. If this is the first time you hear this name and, at first glance, nothing bothers you, then you should still learn about the symptoms, causes, types, diagnosis and treatment of the disease.

Erythema nodosum on legs

What is erythema nodosum?

A pathology called erythema nodosum can be recognized by the presence of compactions (nodules) 0.5-5 cm in diameter in the area of ​​the buttocks, thighs and lower legs. As a rule, damage occurs on two legs at once, symmetrically. It is unpleasant to touch the nodules as it causes pain. The disease occurs in a migratory, chronic or acute form.

What changes does erythema cause?

If a diagnosis of erythema nodosum is made, then a nonspecific inflammatory process is implied. Suffering from fatty and other subcutaneous tissue, the disease negatively affects small blood vessels. The first few hours or 2 days of the disease can be seen under a microscope inflammatory process on the wall of a vein, sometimes on the wall of an artery. There is swelling of the walls of blood vessels and the endothelium at the cellular level, compactions are formed - infiltrates, based on eosinophils and lymphocytes. Hemorrhage in adjacent tissues is also observed.

7 days after the first symptoms of the disease are detected, permanent changes occur. The cellular infiltrate includes giant cells, histiocytes, and lymphocytes. Vessels become impassable. Histiocytes, plasma cells, and giant cells penetrate the fat lobules. In some cases of the disease, a microscopic abscess is created.

The disease progresses, causing it to grow in place of fatty lobules and infiltrates on the walls of blood vessels. connective tissue. It is believed that the disease does not damage the outer dermis and epidermis.

Why is erythema nodosum dangerous?

When erythema nodosum appears, doctors immediately look for hidden pathologies. The fact is that this phenomenon in itself is safe for life. But often erythema nodosum of the legs accompanies various diseases. For example, the underlying disease is still at the stage of development and has no clear symptoms. With erythema nodosum, it is necessary to examine the body as completely as possible for other abnormalities.

Usually erythema recurs, but it does not pose a big threat. You can only talk about danger if there are concomitant diseases. The prognosis for patients is good, since the disease is well studied and can be successfully treated with proven medications. We also note that if there are symptoms of erythema nodosum, a differential analysis should be carried out, that is, other diseases with very similar manifestations should be excluded - erysipelas, Weber-Christian disease, Bazin's erythema and thrombophlebitis.

Erythema nodosum during pregnancy

Women most often encounter the disease erythema nodosum during pregnancy. Doctors have found that pregnant women who took hormonal contraceptives. Some experts argue that the development of erythema in pregnant women is influenced by distorted hormonal background, as a result, unwanted antibodies are formed. It is also worth noting that during pregnancy, immunity decreases somewhat; a weakened body cannot fully protect itself from negative factors, therefore susceptible to disease.

Erythema nodosum in children

Children are also susceptible to erythema nodosum. The disease as a secondary disorder in children develops against the background viral infections, dental diseases, otitis in chronic form, tuberculosis. When it is not possible to identify the provoking diseases, the idiopathic form is diagnosed, that is, a self-occurring process. Children under 6 years of age are less likely to get sick. More girls are at risk. Children are more likely to have erythema in winter and autumn.

Symptoms of erythema nodosum

How erythema most often manifests itself, we will consider further. Dense nodes appear in the subcutaneous fatty tissue or deep-lying tissues of the lower extremities. The skin becomes smooth and characteristic redness. The boundaries of the bumps are blurred due to the fact that the swelling spreads beyond the neoplasm. Pain is usually felt when touching problem areas, and in a state of rest, many patients are not bothered by anything.

Red nodes continue to develop for 3-5 days, then they become denser and turn blue. The appearance of erythema nodosum is often a surprise for the patient. This disease is usually accompanied by general discomfort, loss of desire to eat, chills, and fever. At least 50% of all those suffering from erythema experience joint pain, tension in them increases in morning hours. Joint effusion and swelling are formed. All other manifestations may occur before the formation of the nodes themselves.

The bumps disappear after 14 days, at most 21 days, then they are replaced by peeling and pigmentation. The nodes are healed and at the same time they stop bothering the joints. The duration of the disease is approximately 30 days. In some cases, the pathology is chronic. When single lesions appear from time to time, the joints are not deformed, but are affected.

Diagnosis of erythema nodosum

If erythema nodosum manifests itself, a detailed examination is carried out to obtain full picture diseases, check other organs and systems of the body. Usually, the doctor will immediately order a blood test to check whether the number of white blood cells is elevated and ESR indicator. In case of illness, a culture is taken from the nasopharyngeal mucosa; this analysis often helps to identify an infection of streptococcal etiology. If you have problems with your joints, you should be examined by a rheumatologist.

When the attending physician finds it difficult to make a correct diagnosis, a biopsy of the disease on the lower extremities is performed. For precise definition reasons, you need to perform an ultrasound scan of the veins in the legs, undergo a pharyngo- and rhinoscopy, a CT scan, rheovasography and an x-ray of the lungs.

Causes of erythema nodosum

Erythema on the legs does not form for no reason, so they are always looked for in other places. Until recently, doctors found it difficult to name the provoking factors.

In addition to drugs from the group of oral contraceptives, antibiotics, and other medications, the disease can be provoked by various diseases, such as yersiniosis, tuberculosis, histoplasmosis, sarcoidosis. Among the diseases that cause erythema are also sarcoidosis, colitis, enteritis, leukemia, gonorrhea, neoplasms of malignant and benign nature, syphilis, hepatitis B, chlamydia.

In addition, streptococcal infection and antibacterial antigen increase the likelihood of erythema. Erythema usually develops in people with vascular problems in the legs. These include thrombophlebitis and varicose veins. The most common diseases associated with erythema nodosum are streptococcal infections and sarcoidosis. IN in some cases In ⅓ of patients, erythema nodosum occurs on its own, and infectious and non-infectious causes cannot be identified.

Classification of the disease erythema nodosum

Acute erythema

Acute erythema is based on symmetrically located nodes on the front of the legs in the area of ​​the lower leg, ankle, knee, and sometimes the formations are located on the forearm and foot. It happens that there is no a large number of foci, there are only individual cones. Usually the diameter of the nodes is 0.5-5 cm. The bumps have indefinite boundaries, are swollen, painful on palpation, and hard. Skin at the site of the lesion, pink-red, then bluish, then yellow-green, smooth.

The first manifestation of the disease is the appearance of a small node, which begins to rapidly increase. When it reaches a certain diameter, growth stops. Sometimes patients complain that the bumps, which are painful when touched, also hurt on their own, causing minor or severe discomfort. 21-42 days pass, and the lumps under the skin disappear, no scars remain after them, no atrophic process. Pigmentation and peeling are a temporary consequence and will soon go away.

In acute erythema, as a rule, there are no relapses, patients are not bothered by itching, febrile temperature is kept within 38-39 degrees, there is general malaise, joint and muscle pain. Thanks to the tests, it turns out that there are changes in the composition of the blood that indicate inflammation in the body, for example, an increase in the level of ESR and the number of leukocytes.

Chronic erythema

Erythema nodosum can occur in chronic form. The risk group mainly includes female patients over the age of 40 years, with tumor processes in the pelvis or any chronic disease infectious nature. This disorder can be asymptomatic, and sometimes intoxication produces minor symptoms. The bumps are localized in standard areas of the body; they can be hardly noticeable, since they practically do not create relief on the skin and do not give an atypical color.

From time to time there is an exacerbation of manifestations. This often happens in spring or autumn. Probably, this frequency occurs against the background of an increased likelihood of infection with streptococci during these months. Large joints become covered with pigmentation and swell, the tissues become hot. In rare cases, joints in the hands and feet are affected. When the nodes go away, problems with the joints also stop.

Erythema migrans

Erythema nodosum migrans, as a rule, has a subacute course, which means it does not give severe symptoms, little bothers the person. Is it possible that you feel a general loss of strength, a slight soreness in the joints, low-grade fever within 37-38 degrees, slight chills. After some time, a symptom appears - a limited, hard and flat seal of red-blue color forms in front or on the side of the lower leg.

The development of erythema migrans is accompanied by movement of the infiltrate; a round plaque appears, bright at the edges, light and retracted in the middle. After all these changes, both legs become covered with small nodules. After 14-60 days, the seals resolve.

Treatment of erythema nodosum of the lower extremities

Which doctor should I contact for erythema nodosum?

If symptoms similar to those described above appear, you should urgently make an appointment with a rheumatologist. So that the doctor receives full information O possible reasons disorders, the patient may be referred to other doctors, for example, a pulmonologist, gastroenterologist, ENT specialist, venereologist, oncologist, infectious disease specialist and gynecologist. To diagnose problems with veins in the legs, you need to be examined by a phlebologist.

Pharmaceutical drugs against erythema nodosum

Traditionally, erythema is treated with antiviral, antibacterial, antifungal drugs. Let's name popular options for medications from different groups:

• antihistamines - Cetirizine, Loratadine and Suprastin;
• nonsteroidal anti-inflammatory drugs - Diclofenac, Movalis, Celecoxib and Nimesulide;
• aminoquinoline drugs work well in complex and recurrent cases - Plaquenil and Delagil;
• corticosteroid medications are used if NSAIDs (non-steroidal anti-inflammatory drugs) do not work - Methylprednisolone and Prednisolone.

Ointments for erythema nodosum

In addition to taking tablets, it is important to carry out local treatment with special ointments. External treatment can speed up the resorption of seals. For this purpose, anti-inflammatory ointments, creams with hormones, and lotions with dimexide are usually prescribed.

Additional measures for treating erythema

In addition to tablets and ointments, there are the following measures help with erythema nodosum:

• extracorporeal techniques, for example, plasmapheresis;
• purifying blood irradiation with laser - hemosorption;
• physiotherapeutic measures - laser therapy, magnetotherapy, phonophoresis, ultraviolet irradiation.

Treatment of erythema nodosum with folk remedies

No need to rely on funds traditional medicine if there is any suspicion of erythema nodosum. Herbal therapy in best case scenario will be useless, at worst it will take a lot of time, and in the meantime the pathology will progress silently. Despite the real danger, many are treated with folk remedies at their own peril and risk. There is no need to do this, as they can actually develop serious complications. Herbal medicine is only permissible in as a last resort, exclusively as additional remedy and if the attending physician does not mind.

You cannot diagnose yourself and choose medications on your own. The fact is that pharmacies strong drugs can give side effects if used incorrectly without consulting a doctor.