Nodal erythema of the lower extremities - causes of the disease and methods of treatment
Jul 17, 2018
Nodal erythema of the lower extremities is a common dermatological disease characterized by inflammatory lesions of the skin and subcutaneous tissues. It is manifested by the formation of dense, painful to the touch nodules, located symmetrically on both extremities. This pathological condition was first described by the English dermatologist R.Villan in 1798.
Representatives of both sexes suffer from this disease, but women aged 15 to 30 years are afflicted three times more often than men. It is believed that this is predominantly a woman's disease, as the disease often manifests itself in the period of gestation or when taking hormonal contraceptives. In addition, nodal erythema may be a sign of many serious illnesses. What causes the appearance of pathology, how it manifests itself and by what methods is treated, you will learn from this article.
- 1 Nodal erythema of the lower limbs - causes of the disease
- 2 How does the disease develop?
- 3 Symptoms - photos of
- 4 Diagnosis methods
- 5 Treatment of erythema of lower extremities
Nodal erythema of lower extremities - causes of
disease For many years, erythema nodular was considered to be a specific nosological unit in dermatology. But, recent studies have shown that, in fact, cutaneous pathology is one of the manifestations of allergic vasculitis. Every third patient of erythema develops as an independent disease, and classifies it as primary. In all other cases, the disease occurs against the background of accompanying pathologies and is defined as a secondary form.
What causes sensitization of the body and lead to the appearance of characteristic symptoms? First of all, this is a lot of infectious and non-infectious factors. A certain role in the development of the inflammatory process is played by genetic predisposition.
For infectious reasons include the following co-morbidities:
- streptococcal infections;
- cat scratch disease;
- of iersiniosis;
- cytomegalovirus infection;
- virus Epstein-Barra;
- hepatitis B;
- venereal diseases( syphilis, gonorrhea, etc.);
- inguinal lymphogranulomatosis.
Among non-infectious factors, the following conditions are noted:
- inflammatory bowel disease( ulcerative colitis, Crohn's disease, proctitis);
- Hodgkin's disease;
- leukemia( blood cancer);
- neoplasm( benign and malignant);
- Behcet's syndrome;
In addition, the cause of nodal erythema may be the vaccination or taking certain medications( salicylates, sulfonamides, antibiotics, hormonal contraceptives, iodides).Specialists note that patients with allergic diseases( pollenosis, atopic dermatitis, bronchial asthma), vascular disorders( atherosclerosis, varicosity), or with foci of infection in the body( pyelonephritis, tonsillitis, etc.) are predisposed to the development of nodal erythema.
How does the disease develop?
Nodal erythema of the lower limbs is defined as a nonspecific immune-inflammatory syndrome. To date, the mechanisms of its development have not been studied to the end. Scientists suggest that the provocateurs are a variety of infectious agents and certain chemicals contained in medicines.
They create a definite antigenic background, which the healthy organism does not react at all, but with a genetic predisposition gives an immune response and triggers a series of biochemical reactions aimed at producing antibodies. Since pathology often manifests itself during pregnancy, it is associated with changes in the hormonal background and malfunctions in the functioning of the immune system, as a result of which a woman's body can not resist the influence of negative factors.
In the international classification of diseases of pathology, the code "node erythema μB 10- - L 52" was assigned. The development of nodal erythema begins with the defeat of small blood vessels of the lower extremities. In this case, the fat tissue, located on the border of the dermis and subcutaneous fat, is subject to changes.
In the first two days of the onset of the development of the pathological process, the inflammation covers the walls of the veins( less often the arteries).Vascular wall cells swell, they contain seals( infiltrates), consisting of eosinophils and lymphocytes. In the surrounding tissues, hemorrhages are noted.
About a week after the appearance of the first dysfunctional symptoms, characteristic changes in the composition of the cellular infiltrate begin to develop. Vascular obstruction develops, lymphocytes, plasma and giant cells appear in fat lobes, the probability of forming microabscesses increases. Further infiltrates in the vascular walls and fatty segments are transformed into connective tissue. In this case, the epidermis and the upper layer of the dermis are usually not involved in the pathological process.
Symptoms - photos of
The main characteristic symptom of the disease is the appearance of dense nodules with a diameter of 1 to 5 cm in the lower tissues of the dermis and subcutaneous fat. Nodules slightly rise above the skin, have clear outlines, surrounding tissues swell, and the skin above the seal becomes red and smooth. After a few days( from 3 to 5) the nodes become denser, the skin over them acquires a cyanotic shade and gradually turns yellow, as with a hematoma. Visually, these manifestations resemble a bruise.
Inflamed seals are usually located on the anterior or lateral side of the tibia and are symmetrical on both legs. In addition, erythema elements appear in the subcutaneous fat layer on the calves, thighs, buttocks, forearms, or face. Nodules grow rapidly to a certain extent, with no itching, but the patient feels a pain that increases when the seal is probed.
The disease usually begins suddenly and is accompanied by a general deterioration of well-being. The patient complains of weakness, lack of appetite, febrile condition, chills. Sometimes articular pains arise, morning stiffness, symmetrical inflammation of the joints. There is swelling in the area of small joints of the hands and feet, which makes diagnosis difficult, since such manifestations are perceived as symptoms of arthritis.
After 2 - 3 weeks the nodes disappear, and together with them the joint and skin manifestations of the disease go away. But in some cases, the disease takes a chronic course and periodically recurs. When exacerbations appear dense individual nodes with a bluish tinge, painful on palpation. The chronic form of nodal erythema can persecute the patient for several months.
Nodal erythema of lower extremities in children
Nodal erythema is more often diagnosed in girls and manifests itself in the cold season or in the off-season. The development of the disease contributes to the presence in the body of a causative agent of a viral nature or such infectious agents as staphylococcus, streptococcus, candida. The disease begins acutely, children have painful, hot to the touch nodes on the front of the lower leg, hips or forearms.
There is general malaise, the child is naughty, refuses to eat, his temperature rises, chills and headaches. The nodes are dense, hemispherical, rising above the surface of the skin, the skin around them inflamed and swollen.
A distinctive feature of such nodes is the gradual color change. First they turn from red to bluish, then their shade gradually turns into yellowish green. At this stage, the nodes are resolved and become flat. In this case, the peculiar color of the nodes resembles bruises that have remained from bruises.
This is clearly seen in the photo of the erythema of the lower extremities. In children, the disease is often accompanied by joint damage, with characteristic manifestations: soreness, swelling, redness of the skin. A few days later, the inflammatory process subsides, but soreness in the joints remains for some time.
The duration of the disease is usually 3 to 4 weeks. With the disappearance of nodes on the skin may remain peeling and pigmentation, which eventually pass. With repeated relapses of the disease, a thorough examination of the child is necessary. A timely treatment will avoid possible complications and the transition of the disease to a chronic stage.
Types of nodal erythema
Depending on the clinical features and severity of symptoms, experts distinguish the following types of erythema:
- Acute.The main symptom is the formation of painful symmetrical nodes in the region of the shin, knee and ankle joints. The disease begins suddenly and is accompanied by a deterioration of well-being: fever, chills, joint and headaches. The nodes are clearly defined, dense, the skin around them is hyperemic and inflamed. The process can involve large and small joints, which is accompanied by increased pain. The skin over the seals swells, turns red, becomes hot to the touch. After the disappearance of nodules, inflammation of the joints also subsides.A distinctive sign of erythema is a change in the color of the nodes, over time they turn from the red to bluish, then turn yellow and resemble traces of the hematoma. Seals are resolved and become flat after 3-4 weeks from the onset of the disease. After their disappearance, there is no scars left on the skin, but the peeling and pigmentation persists for some time.
- Chronic.This type of nodular erythema is predominantly diagnosed in women after 40 years of age who have a history of tumor-like processes in the pelvic organs or chronic foci of infection in the body. In this case, the symptoms of intoxication are completely absent or poorly expressed and the patient's well-being does not change. Nodal seals are localized in typical places: on the shins, hips, buttocks, but visually they are invisible, since they do not rise above the surface of the skin. The inflammatory process is absent, and surrounding tissues are not subjected to changes, the skin does not change color, redness and puffiness does not arise. Some increase in symptoms is noted only during the exacerbation of the pathological process, which occurs most often in the off-season.
- Migrating.The course of this form of the disease is manifested by less acute symptoms. The temperature rises slightly, the patient feels chills, weakness, pain in the joints of moderate intensity. Then on the front surface of the shin appears a single dense, clearly delineated knot, painful during palpation. The form of the seal is flat, practically not towering above the skin, the color of the element is red-cyanotic. As the disease progresses, the inflammatory element is able to migrate, with the formation of a plaque, the center of which is pale, and the edges along the periphery acquire a bright red hue. Later on, several small compacted nodes may appear on both shins. Regression of erythema occurs 4-8 weeks after the onset of the disease.
An experienced dermatologist can easily diagnose correctly based on general examination and clinical symptoms. To clarify the diagnosis, a number of laboratory tests are prescribed:
- a general blood test;
- bacteriological culture;
- biopsy of nodular formation;
- histological examination.
If necessary, the patient is referred for ultrasound dopplerography of the vessels of the lower extremities, computed tomography or rheovasography. To determine possible provoking factors and to identify concomitant foci of infection in the body, the patient is referred for consultation to other specialists: phlebologist, vascular surgeon, pulmonologist, infectionist, otolaryngologist, rheumatologist.
Treatment of erythema of the lower extremities
Based on the results of the diagnosis, the physician selects the treatment regimen on an individual basis. It should be aimed not only at suppressing the symptoms of the inflammatory process, but also at eliminating the provoking factors that cause the development of pathology. Complex therapy for nodal erythema includes the following measures:
- Application of antibacterial therapy aimed at suppression of the inflammation focus;
- Application of external preparations( ointments, creams) with anti-inflammatory and regenerative action;
- Treatment of NSAIDs( non-steroidal anti-inflammatory drugs);
- Taking antihistamines and desensitizing agents;
- Physiotherapeutic procedures.
Patients are advised to comply with bed rest. Chronic foci of infection in the body are suppressed with antibacterial drugs( penicillin, erythromycin, doxycycline), antifungal and antiviral agents. Assign anti-inflammatory drugs( Diclofenac, Ibuprofen, Indomethacin), salicylates( Ascophene, Aspirin).In the treatment regimen necessarily include antihistamines, suppressing the nonspecific reaction of the immune system( Tavegil, Claritin, Suprastin, Zirtek).
If infectious diseases are absent, corticosteroids are used to quickly eliminate the inflammatory process( Prednisolone, Methylprednisolone).With recurrent and chronic forms of the disease, the use of aminoquinoline preparations( Plakvenil, Delagil) is indicated.
Local treatment is based on the use of external agents with anti-inflammatory action: hormonal ointments( Sinaphlan, Acriderm), compresses with Dimexide. The use of extracorporeal methods helps to quickly eliminate painful symptoms: laser irradiation of blood, plasmapheresis, hemosorption. To restore the vessels used drugs - angioprotectors( Trental, Delagin, Escuzan).
A good effect is provided by physiotherapy. For the treatment of nodal erythema, the following methods are used:
- Phonophoresis with hydrocortisone;
- Laser irradiation;
- Compresses with Dibulon or Ichthyol solution.
At the final stage of therapy, the patient is prescribed the use of immunomodulating agents and vitamin-mineral complexes.
After curing a patient for a month, it is recommended to avoid high physical exertion. In order to prevent further relapse, a hypoallergenic diet should be followed.
It is necessary to avoid the use of products that can cause an allergic reaction, refuse from roast, smoked, salted, spicy and give preference to milk and vegetable ration. It is timely to treat foci of infection in the body, lead an active lifestyle, maintain immunity and enhance the body's defenses.
Nodal erythema during pregnancy
Earlier it was thought that the appearance of erythema nodal symptoms during pregnancy poses a threat to the full development of the fetus. To exclude the birth of a child with congenital abnormalities of development, women were offered an artificial termination of pregnancy.
Currently, the extensive capabilities of modern diagnostic methods allow reliably to establish a kind of infectious agent that provokes the inflammatory process. This makes it possible to understand what factors do not have any influence on the development of the embryo.
In acute forms of nodal erythema, the main burden is on the female body, the cardiovascular system of a woman experiences a toxic effect, whereas this inflammation process does not affect the development of the child. In some cases, nodal erythema can even pass by the end of 2 or 3 semesters.
Since drug treatment during pregnancy is not desirable, specialists are limited to the appointment of external agents with anti-inflammatory and analgesic effect. With exacerbation of the disease, a woman is recommended bed rest and restriction of any psychoemotional worries. In addition, the doctor can recommend the optimal combination of motor loads with rest. Later, after delivery, this tactic of treatment will help to avoid the transition of the disease into a slow chronic form.
In itself, such a disease as nodal erythema of the lower limbs is not dangerous, but it is often a companion of many severe pathologies. Therefore, timely access to a doctor and a survey can help identify and eliminate the concomitant disease and thereby prevent possible complications. If you have anxious symptoms, you should consult a rheumatologist or dermatologist. When prescribing treatment in the early stages of the disease, the prognosis is usually favorable.