Erythema nodosum on the legs treatment. Get treatment in Korea, Israel, Germany, USA

The condition of the skin concerns not only women.

Every person experiences anxiety when any rashes or other changes appear on their body. One of the problems requiring special attention, is erythema nodosum. What is erythema

is a disease that affects skin covering. The development of erythema nodosum is due to sensitization of blood vessels in the subcutaneous tissue.

The pathological process is caused by infections, allergies to medications, and may indicate the development of another illness:

sarcoidosis
intestinal diseases
diseases associated with tumors or infections

The reason may also be the use hormonal contraception. The disease manifests itself in acute and chronic forms.

Symptoms

First, there is a deterioration in the general condition. Then knots appear on the knees, legs, and a little less often on the neck and face, which hurt when touched. They have a reddish tint, changing first to purple, and then become brown and yellowish color. Most sick people experience joint inflammation.

In the chronic form, the condition passes for a short time, the nodes merge or appear in other places, and migrate.

Which doctor should you contact?

Diagnosis of erythema nodosum can be performed by a dermatologist or rheumatologist, who will also tell you how to cure erythema nodosum. They prescribe the following studies:

Features of treatment for children

Basically, the symptoms of the disease are similar in adults and children. However, some specificity is still observed. In children, the disease is often considered the first sign of tuberculosis infection.

It is often accompanied elevated temperature, an increase in ESR, as well as chills and joint pain. Sometimes there is an upset stomach. In babies preschool age erythema nodosum develops as a consequence allergic reaction for tuberculosis infection.

In children, the pathology is represented by acutely inflammatory painful nodes on the thighs, legs, and forearms. The nodes are tense and swollen, without clear boundaries, rising above the skin. Their coloring resembles bruises.

The size of these formations varies - from a small pea to hazelnut. In rare cases, peeling may occur over the rash. When during the examination it is determined that the child’s illness is not caused by tuberculosis, then treatment for erythema nodosum consists of prescribing: Naprosin, Brufen, Aminocaproic acid, Reopirin and Calcium Gluconate.

Treatment of erythema nodosum in children: inflamed areas are lubricated Acemin, Vishnevsky ointment or Ichthyol ointment. Vitamins Aevit, group B, Rutin are also prescribed. Positive dynamics are observed in the first week of fighting the disease. If the disease reappears, a more thorough diagnosis of the child’s body for tumor formation is necessary. stomach diseases, rheumatism.

Treatment of erythema nodosum during pregnancy

The disease is also merciless to pregnant women. The danger of erythema nodosum for this group of people is the occurrence of heart complications. For the fetus, these factors are of no importance negative influence they do not provide.

If there is a disruption in the heart's activity, the doctor will recommend that the pregnant woman go to bed for conservation. In the absence of complications, erythema nodosum in pregnant women is treated with ointments Indovazin, Deep Relief and Diclofenac. The technique is also shown Chimes, Paracetamol And Aspirin in small doses. Most effective in treating erythema nodosum during pregnancy indovazine.

It is advisable to reduce the load on the lower limbs during this period. Bed rest is prescribed, alternating with light physical activity. This is caused by the fact that pregnant women do not get rid of the disease after childbirth. Erythema nodosum develops into a chronic form, manifesting itself in interseasonal relapses when climatic conditions change.

How and with what to treat erythema nodosum?

sanitation of foci of infection
dry heat purpose
cool compresses
taking non-steroidal anti-inflammatory drugs
potassium iodide

Antibiotics are recommended (Erythromycin, Ceporin, Kefzola), anticoagulants, angioprotectors, desensitizing agents. In treatment erythema nodosum Ultrasound therapy is effective in the lower extremities. It is also advisable for the patient to undergo a course of laser therapy, magnetic therapy, and inductothermy.

Treatment of erythema nodosum on the legs at home with folk remedies

Folk remedies play an important role in the treatment of erythema nodosum. Folk treatment of erythema nodosum offers many recipes:

You can make an ointment for external use based on plantain leaves, raspberries, blackberries and birch buds. Grind the plant material, mix in equal proportions with the melted lard or castor oil. Simmer the mixture in a water bath for about an hour, then filter while heated, cool and rub into problem areas of the skin twice a day.

Also for the treatment of erythema nodosum of the lower extremities folk remedies you can prepare an ointment from 100 g dry arnica roots, which are ground in a mortar in advance. Mix the powder with pork fat. Then boil the mixture over low heat for about 3 hours, remembering to stir. After cooling, treat skin three times daily.

It is useful to take baths from the decoction oak and willow bark, fruits walnut, as well as linden flowers, raspberry branches and black elderberry. Nettle gives good results in the treatment of erythema nodosum. Grind the raw materials and pour into a large spoon herbal mixture liter of boiling water, leave for about 15 minutes, then pour the liquid into the bath. Accept water procedure no more than a quarter of an hour.

The effect in the treatment of acute forms of the disease is achieved choleretic agents prepared from healing berries and herbs. Mix the leaves of birch, lemon balm, lingonberry, mint, immortelle and yarrow, take one large spoon of herbs and brew in half a liter of boiling water. Leave for half an hour and take one third of a spoon 20 minutes before meals.

All preventive measures aimed at preventing the appearance of erythema nodosum consist of the need to promptly improve the health of the body. Erythema nodosum on the legs treatment

The disease got its name thanks to characteristic symptoms. On the affected areas, most often in the lower extremities, dense nodes with a diameter of 5 mm to 5 cm begin to appear.

IN medical literature You can also find the name erythema nodosum. Experts classify the pathology as a type of allergic vasculitis.

Inflammation of the walls of blood vessels develops as a reaction of the body to the effects of various toxic factors.

Most often, young people aged 20–30 years face pathology. Statistics show that women develop the disease more often. Exacerbation in most cases occurs in the winter-spring period.

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

Causes and mechanisms of development of erythema nodosum

The body's immune response

With regard to the mechanisms of disease development, most authors give primary importance to the hypothesis of immune reaction immediate or delayed response to bacterial, viral or other provoking antigens.

The fairly frequent development of the disease after taking certain medications and the similarity of skin elements in erythema nodosum to rashes in allergic diseases confirms the assumption of the allergic nature of this pathology.

The skin is an area that quickly responds to the influence of a provoking agent. Under its influence are produced immune complexes, which, circulating in the blood, settle and accumulate on the walls and around the walls of small vessels (venules) located in the connective tissue partitions of the subcutaneous tissue.

Causes of erythema

According to research by modern scientists, erythema nodosum is one of the variations of allergic vasculitis.

The most common cause of erythema is an infection in the body, namely streptococcus.

Red nodules form in the following diseases:

erysipelas;
sore throat and otitis media;
acute pharyngitis;
streptoderma;
rheumatoid arthritis;
cystitis.

Damage to the vascular wall develops in the following conditions:

sarcoidosis;
during pregnancy;
with the development of various oncopathologies.

patients with vascular pathologies - varicose veins veins, formation atherosclerotic plaques in vessels;
people prone to allergic reactions - hay fever, bronchial asthma, atopic dermatitis;
the presence of inflammatory processes in the gastrointestinal tract - Crohn's disease, colitis;
presence chronic infections- sinusitis, tonsillitis, pyelonephritis.

The use of certain medications can also lead to the development of this pathology. Such means include:

antibacterial drugs;
sulfonamides;
oral contraceptives.

Deep roots of erythema nodosum for a long time tried to find it, but to no avail.

To be fair, it should be said that even today the cause of the disease is not yet fully understood.

We have only considered some of the factors that provoke the appearance of erythema nodosum.

Pregnant women and women taking contraceptive and hormonal medications are at risk.

European and American doctors have discovered a connection between erythema nodosum and:

yersiniosis;
histoplasmosis;
sarcoidosis;
tuberculosis;
streptococcal infection.

It is difficult to dispute the fact that erythema nodosum is a response to taking contraceptive medications.

Doctors have proven that erythema nodosum occurs most often in women, susceptible to diseases vessels of the lower extremities:

thrombophlebitis;
varicose veins.

You can pay attention to a similar incidence among pregnant women.

A blood test shows an increased sedimentation rate of red blood cells - erythrocytes.

Typically, doctors examine for erythema nodosum:

gastrointestinal diseases;
lupus erythematosus;
tuberculosis.

Cultures from the uterine pharynx are required to detect streptococcus.

Sometimes, erythema nodosum is an independent disease.

In this case, searching for the cause of the disease becomes meaningless and even impossible.

Erythema nodosum occurs in two main forms:

Depending on the form of diagnosis, the manifestations of the disease are distinguished.

Acute erythema most often affects girls who are sensitive to the tuberculosis test.

The acute phase of erythema is manifested by red spots, and only then, the color of pigment spots may change depending on the shape and stage of attenuation.

Sick people experience:

chills;
joint pain;
in the shoulder area;
hips;

The development of the disease is based on infections, primarily streptococcal: scarlet fever, tonsillitis, streptoderma, acute pharyngitis, otitis media, erysipelas, cystitis, arthritis, etc.

, – and tuberculosis. Less commonly, the root cause is coccidioidomycosis, yersiniosis, inguinal lymphogranulomatosis, trichophytosis.

In addition, drug sensitization may be a cause.

The development of inflammation of blood vessels and subcutaneous fat is most often promoted by various infectious processes in the body. Unpleasant symptoms can develop as a result of diseases:

angina;
cystitis;
otitis media;
streptoderma;
tuberculosis;
rheumatoid arthritis;
scarlet fever, etc.

Skin nodules can develop as side effect drug therapy. Erythema nodosum often appears after vaccination or taking antibiotics.

People suffering from cancer pathologies also have to deal with inflammation of the vascular walls. People with lymphoma are most susceptible to erythema nodosum.

People with blood and vascular diseases (varicose veins, vascular atherosclerosis) are predisposed to the chronic course of the inflammatory process. Allergy sufferers, as well as women during pregnancy, are at risk.

IN medical practice There are familial cases of erythema nodosum. Great importance It has hereditary predisposition to the development of the pathological process. If parents suffer from the disease, there is a risk of developing inflammation in the child.

Prevalence

Erythema nodosum occurs in 5-45% of the population, especially often in young people. As a result of epidemiological studies, it was found that in different regions the incidence rate varies significantly and largely depends on the predominance of a particular pathology characteristic of a particular area.

However, complete statistics on the prevalence of this disease are insufficient. It is only known that in the UK, 2-4 cases are registered per 1000 population every year.

The name of the disease was proposed at the end of the 18th century. , and its clinical symptoms were described in detail in the second half of the 19th century.

In subsequent years, some features of the clinical manifestations of erythema nodosum in many infectious processes with a chronic course were also described, various treatment regimens were proposed, but still specific etiological factor has not been established, and the frequency of chronic forms remains quite high.

Differences in incidence of disease between urban and rural population, as well as between the sexes adolescence not noted. However, after puberty, girls and women are affected 3-6 times more often than boys and men.

It is generally accepted that pathology develops mainly against the background of other diseases, of which sarcoidosis is the most common. Although people of any age are at risk of developing erythema nodosum, young people 20-30 years of age are more often affected.

This is due to the fact that the maximum incidence of sarcoidosis occurs precisely in this period. age period. Often, after an X-ray examination of the chest organs, sarcoidosis was discovered in patients who presented with a clinical picture of erythema nodosum.

Most often, erythema nodosum is a sign of some other serious disease. The causes of this pathology are different:

photo shows erythema nodosum on the legs

Often this pathology manifests itself during pregnancy. During pregnancy, the female body is weakened and loses its resistance negative impact.

There are many cases where the disease is a syndrome of the immune inflammatory process, but genetic disposition also plays an important role.

Types of erythema nodosum

The rash may develop in adults as independent disease. In this case, the pathology is primary.

If vascular inflammation occurs against the background of another pathological process in the body, we are talking about secondary erythema nodosum. The disease can develop on the arms or legs.

Most often, unpleasant symptoms appear on lower limbs.

Depending on the causes of the disease, the following types are distinguished:

Erythema infectiosum. The disease develops against the background of various infections in patients of any age.
Multiform exudative erythema. The disease develops against the background of a cold and may be accompanied by pain in the throat and joints. Nodes form not only on the extremities, but also on the mucous membrane of the mouth and in the genital area.
Ring-shaped erythema. The disease is classified as chronic. The pathology can develop against the background of allergic reactions or a long-term infectious disease. Rounded nodules eventually merge into rings.
Erythema migrans. Pathology manifests itself as a result of a tick bite.

Toxic erythema is a disease that develops in a child in the first days of life. Small red lumps appear on the baby's body. After a few days, the rash goes away on its own. Special treatment not required.

The disease can manifest itself in acute form. But more often you have to deal with secondary chronic inflammation. To completely remove unpleasant symptoms, it is necessary to cure the underlying disease.

There are several types of erythema nodosum, the treatment of which is slightly different. From photographs of patients with various inflammatory formations, it is difficult for a non-specialist to determine what is the difference between one type of pathology and another.

Highlight the following types Erythema nodosum:

Symptoms of the disease

At the onset of the disease, as a rule, patients feel unwell, have a high temperature, sore throat and even diarrhea. There is rarely a cough and hoarseness. In addition, before the characteristic nodules appear, there may be swelling and pain in the joints.

Patients at the beginning do not even suspect that anything is troubling, because the symptoms of the disease correspond to those of a common cold. Over time, subcutaneous nodules begin to appear, which indicate erythema nodosum. As the disease progresses, they change their color to brown and then green.

They appear on the very front surface of the leg and reach a diameter of one to several centimeters. The nodules can merge with each other, due to which their size reaches up to 10 cm. They are easily noticeable and the skin in their place is warm and reddened.

Nodules in erythema nodosum resemble bruises in appearance and are painful. If they appear in the lower part of the limb, they can even cause difficulty walking. Therefore, patients with such symptoms should remain in bed.

Of course, the most common manifestation of this disease is the formation of nodules. To the touch, the formations are hard, flat, and during palpation they have an increased temperature, with a diameter of 5 mm to 5 cm. The following symptoms are also described:

the nodules do not have clear boundaries, the nearby skin begins to redden and swell, there is no itching;
the skin in the affected area begins to thicken and change its color; this process can be observed when a bruise forms.
nodular formations grow very quickly, but reach a certain size. Patients feel painful sensations not only during palpation, but also when walking, lifting weights and even light physical activity.

The symptoms of the disease are quite specific and can be diagnosed quickly and accurately by an experienced specialist. It is important that the patient pays attention to skin changes. They can easily be confused with a regular bruise after a blow or injury: the appearance is accompanied by a blue discoloration that goes away after 2-3 weeks. Main differences from mechanical damage vessels – mass formations and absence external conditions for their appearance. Symptoms of erythema nodosum:

dense nodular warm formations in the deep layers of the skin and subcutaneous tissue without breaking the skin;
lack of clear boundaries, the neoplasm itself is expressed in red color;
swelling of adjacent tissues;
no itching;
light gloss on the hearth;
nodes grow to a certain size and remain so until destruction;
pain on palpation;
the area of formation thickens as if a hematoma develops.

Acute erythema nodosum

Considered normal classic look disease, but less common is acute erythema nodosum. Unlike the migratory or chronic form, it appears suddenly with multiple manifestations on the anterior and lateral sides of the legs (in rare cases, on the thighs).

Some lesions may merge into single large spots. Characteristic complete absence itching, pain symptoms can appear without external influence, and the spots will become very red.

Acute erythema nodosum often appears against the background of infectious diseases: acute respiratory viral infections, tonsillitis and similar ones. Initial period characterized high temperature body and flu-like symptoms during the onset of the disease: aching joints, muscle pain, general weakness.

Individually, inflammation of the joints, as in arthritis, and severe swelling are possible. Granulomas resolve on their own within 3 to 6 weeks, depending on the severity of the case.

Primary treatment should be infection, erythema is a side symptom.

- Single red painful nodules rising above the surface of the skin; located on the front surface of the legs, occasionally on other parts of the body. - Possible weakness, fever and arthralgia, rarely - arthritis. - Increased ESR.

Depending on the severity, nature of the course and duration of the inflammatory process, the following forms of the disease are distinguished:

Spicy.
Migrating.
Chronic.

It is a classic type, but not the most common variant of the course, the development of which is usually preceded by an acute infectious disease (tonsillitis, ARVI, etc.).

The most characteristic feature the disease is nodules. Initially, these seals are hard, flat, and hot to the touch. Erythema nodosum is sometimes accompanied by other symptoms. Symptoms may include the following:

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

Diagnostics

It will not be difficult for a qualified dermatologist to put correct diagnosis already at visual inspection inflamed areas. However, this is not enough to prescribe adequate therapy.

It is important to identify the reason for the development of inflammation of the vascular walls. The following techniques can be used for this:.

General blood analysis. An increase in the number of leukocytes, a change in ESR - all this may indicate the development of an inflammatory process.
Culture from the nasopharynx. The study allows you to detect the presence of streptococcal infection in the body.
Carrying out a tuberculin test. The study is carried out if a patient is suspected of having tuberculosis. For the same purpose, the patient needs to have a chest x-ray.
Blood test for platelets. An increase in the indicator indicates the development of vascular pathology.
Biopsy of one of the nodules. The study is carried out if a visual examination makes it difficult to make a diagnosis.

To determine the factor contributing to the development of the inflammatory process, the following diagnostic procedures can additionally be performed:

rhinoscopy;
pharyngoscopy;
CT scan;
Ultrasound of the veins of the lower extremities.

The patient may need consultations with specialists such as a phlebologist, vascular surgeon, oncologist, pulmonologist, infectious disease specialist, etc.

In making a diagnosis, the main role is played by external examination and careful collection of anamnesis (medical history). Anamnesis allows us to identify concomitant and/or previous diseases against which erythema nodosum developed and which may be its main cause.

A mandatory examination is radiography or, more reliably, computed tomography of the chest organs. The presence in the study results of bilateral enlargement of intrathoracic lymph nodes in combination with erythema nodosum and elevated body temperature and in the absence of symptoms of pulmonary tuberculosis usually indicates Löfgren's syndrome.

It often occurs in women during pregnancy and the postpartum period. Löfgren's syndrome is one of the types mild course pulmonary sarcoidosis requiring appropriate therapy.

What tests need to be taken?

General blood tests are not very informative. They can only indicate (not always) the presence of an inflammatory ( accelerated ESR) and/or allergic (increased number of eosinophils) process.

To some extent, tests to determine the titers of antistreptolysin-O in two samples with an interval of 2-4 weeks are useful. A change in titer of at least 30% indicates an inflammatory streptococcal infection in the recent past.

In particularly difficult cases, as well as in case of resistance to treatment and persistent course of the disease, in order to carry out differential diagnosis, a biopsy of the affected area is performed, followed by histological examination (the histological picture is described above).

Although this disease and has characteristic symptoms and signs, only a doctor can confirm the diagnosis. In this case, the patient needs to visit not only a dermatologist.

He may need to consult a rheumatologist, therapist and other specialists who will determine the causes of this pathology and prescribe adequate treatment.

Erythema nodosum is most often diagnosed immediately upon examination. The patient takes a throat swab, which is tested for streptococcus.

It is also necessary to take an x-ray of the lungs to rule out causes of the disease such as tuberculosis and sarcoidosis. Sometimes, to confirm the diagnosis, the patient submits stool, which is examined for the presence of Yersinia pathogens.

This erythema disease is different increased speed erythrocyte sedimentation. Its characteristic feature is that in some cases it is not possible to determine the underlying disease that led to the pathology. In this case, erythema nodosum is considered an independent disease.

An important point is differential diagnosis, which allows one to exclude diseases such as vasculitis.

Based on the patient’s complaints, medical history and life history, taking into account the data objective examination, the doctor will make a preliminary diagnosis of “erythema nodosum.” To confirm or refute it, a number of additional laboratory and instrumental studies, namely:

Clinical blood test (it will determine the signs of an inflammatory process in the body: neutrophilic leukocytosis, ESR increased to 30-40 mm/h, that is, the erythrocyte sedimentation rate.
Blood test for rheumatoid tests (rheumatoid factor will be detected in it).
Bacterial culture from the nasopharynx (carried out to search for streptococcal infection).
Tuberculin diagnostics with 2 tuberculin tests (carried out in case of suspected tuberculosis).
Stool culture (if yersiniosis is suspected).
Biopsy of nodular formations followed by microscopic examination taken material (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 to subcutaneous fatty tissue).
Rhino- and pharyngoscopy (to search for chronic foci of infection).
X-ray of the chest organs.
Computed tomography of the chest organs.
Ultrasound of the veins and rheovasography of the lower extremities (to determine their patency and the severity of inflammation).
Consultations with specialists in related specialties: infectious disease specialist, otorhinolaryngologist, pulmonologist, phlebologist and others.

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

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

Thrombophlebitis. Painful lumps on the skin with this disease they resemble those with erythema nodosum, however they are located exclusively along the veins and have the appearance of tortuous strands. The limb is swollen, the patient complains of muscle pain. The general condition of the patient, as a rule, does not suffer; if the blood clot becomes infected, the patient notes weakness, increased body temperature, sweating and other manifestations of intoxication syndrome.
Erythema Bazin (the second name is indurative tuberculosis). Rashes with this disease are localized on the back of the lower leg. The nodes develop slowly, they are not characterized by signs of inflammation, and there is no noticeable separation from surrounding tissues. The skin over the nodes is red-bluish, but a change in its color as the disease progresses is not typical. Often the nodes ulcerate, leaving behind a scar. As a rule, women suffering from tuberculosis are ill.
Christian-Weber disease. This disease is also characterized by the formation of subcutaneous nodes, but they are localized in the subcutaneous fatty tissue of the forearms, torso and thighs, small in size, and moderately painful. The skin over the nodes is slightly hyperemic or not changed at all. They leave behind areas of fiber atrophy.
Erysipelas(erysipelas). This is an acute infectious disease, the causative agent of which is β-hemolytic streptococcus of group A. Erysipelas debuts acutely with a rise in temperature to febrile values, severe weakness and other symptoms of general intoxication. After some time, burning, pain and a feeling of tension appear in the affected area of the skin, followed by swelling and hyperemia. The area of redness is clearly demarcated from adjacent tissues, its edges are uneven. Compaction is determined along the periphery. The area of inflammation rises slightly above the skin level and is hot to the touch. Blisters with contents of a serous or hemorrhagic nature, as well as hemorrhages, may form. The radical difference from erythema nodosum is inflammation lymphatic vessels and regional lymph nodes with erysipelas.

Treatment of erythema

When diagnosing erythema, doctors recommend performing basic blood tests and serological testing for the presence of viral antigens. final diagnosis disease, a sample can be taken and subjected to histological examination.

Treatment of erythema often takes a long time. It should be performed by a qualified dermatologist. It is necessary to eliminate factors that may increase the risk of disease (foci of infection and medical supplies). Systemic therapy should be used for a sufficiently long time.

Therapeutic treatment is determined individually for each patient. This is not possible without inspection. This often brings relief

Ichthyol ointment (5-10%),
Salicylic ointment;
Vishnevsky ointment.

If treatment does not bring any improvement, the dermatologist may prescribe corticosteroids. For example, Advantan ointment for topical use.

Before starting treatment, the patient must undergo X-ray examination lungs, so that the attending physician excludes the development of pathologies such as tuberculosis and sarcoidosis.

It is also necessary to take a smear to check for the presence of streptococcal infection in the body. In order to exclude the presence of other infections, additional blood tests must be done.

- Rest. - Treatment of the underlying disease. - NSAIDs (non-steroidal anti-inflammatory drugs), cold compresses.

In order to get rid of the general symptoms of the disease, silicates and a whole group of antihistamines(Claritin, Telfast, Tavegil, Zyrtec, Suprastin, Diazolin).

Depending on the test results, antibiotics may be prescribed.

Self-medication of erythema is strictly prohibited, since medications can lead to serious problems with the gastrointestinal tract.

Skin nodules can often be treated with corticosteroids, but their use is limited to the advice of a healthcare professional.

A person suffering from erythema nodosum is prescribed mandatory bed rest.

Extremely popular treatment methods such as physiotherapy:

diathermy;
warming compresses on the lower leg;
phonophoresis.

People who have had any form of erythema nodosum are recommended to regularly visit seaside resorts (at least once a year), take moderate walks, and give up alcohol and smoking. If possible, avoid cold places, do not do standing work and do not lift heavy objects.

The treatment method for erythema nodosum will greatly depend on the form of the disease, stage of development and accompanying pathologies. In especially severe cases, doctors may prescribe hospitalization or strict bed rest.

Also great attention is given to the diet (spicy, fried, highly salty foods, citrus fruits, coffee, tea and chocolate are completely excluded from the diet).

Even after the disappearance of clinical manifestations of the disease, patients are recommended to adhere to preventive measures for at least a year. Avoid prolonged periods if possible hiking, bruises, hypothermia and nervous breakdowns.

To improve blood circulation and strengthen the walls of blood vessels, doctors may prescribe supportive treatment. Good feedback received sulfur and carbon dioxide baths.

The success of therapy depends on how effectively the pathology contributing to the development of vascular inflammation was treated. The patient may be prescribed systemic antibacterial therapy, sanitation of chronic foci of infection is carried out.

During the acute period, the patient is prescribed bed rest. In the most difficult cases, the patient is hospitalized.

It is necessary to ensure rest for the lower extremities. To improve blood flow from inflamed areas, it is recommended to fix the legs in an elevated position.

Drug therapy for the disease includes the use of the following groups of drugs:

Antibiotics. Medicines from this category are prescribed if vascular inflammation is caused by bacterial infection. Drugs are selected taking into account the sensitivity of pathogenic microflora. Ampicillin, Flemoxin Solutab, etc. may be prescribed.
Non-steroidal anti-inflammatory drugs. These medications relieve painful sensations, normalize body temperature. Nurofen, Ibuprofen, Diclofenac can be used.
Antihistamines. Medicines from this group help relieve swelling and itching. Suprastin and Tavegil show good results.
Corticosteroids. Preparations for external use in the form of ointments help relieve unpleasant symptoms. Prednisolone ointment shows good results.
Aminoquinoline derivatives. Medicines in this category are prescribed for recurrent forms of erythema nodosum. Plaquenil and Delagil may be prescribed.

Compresses with Dimexide will help quickly remove unpleasant symptoms. However, in pure form You cannot use an anti-inflammatory agent, otherwise you may get burned.

The course of therapy is 10 days.

Medications for erythema nodosum - gallery

Physiotherapeutic treatments

After stopping the acute inflammatory process, when the patient’s body temperature returns to normal, they can be used to speed up the recovery process of damaged areas. following methods therapy:

Ural Federal District. Ultra-violet rays have a general strengthening and immunostimulating effect.
Phonophoresis. Using ultrasound, medications are injected into damaged areas.
Magnetotherapy. Due to the influence of the magnetic field, the regeneration of damaged vessels is accelerated and blood flow is stimulated.
Laser therapy. Laser radiation has a vasoconstrictor as well as an immunostimulating effect.

In chronic cases of the disease, plasmapheresis shows good results. The procedure is performed in a hospital setting. The patient's blood is taken, purified and returned to the bloodstream. 4-5 procedures are enough to achieve stable remission.

Traditional methods of treating erythema nodosum

In consultation with the doctor, conservative therapy can be supplemented with drugs traditional medicine. Many of them show high efficiency. However, you should never use them yourself.

Aloe and honey

Some fresh leaves aloe must be combined with the juice of half a lemon and a teaspoon of honey. All ingredients must be thoroughly mixed and eaten. This composition has a powerful immunomodulatory effect. However, the recipe is not suitable for people who are prone to allergies.

Erythema nodosum is a disease that requires careful diagnosis. Most often, it is possible to remove unpleasant symptoms by curing the underlying disease. People who carefully monitor their own health rarely encounter pathology.

If there is a pronounced picture of the disease, it is necessary to adhere to bed rest for a week, which helps reduce swelling of the lower extremities and the intensity of pain.

Drug therapy

For moderate and mild forms of erythema nodosum, treatment begins with the use of one of the drugs from the class of NSAIDs (nonsteroidal anti-inflammatory drugs) - Ibuprofen, Paracetamol, Indomethacin, Ortofen, Diclofenac, Naproxen, Ibuklin, Meloxicam, Lornoxicam, Nimesulide, etc. They are taken for 3-4 weeks.
Antibiotics, antibacterial and virusostatic agents. If possible, it is advisable not to prescribe them to pregnant women in the first trimester. Antibiotics are the safest for the fetus penicillin group(Ampicillin and Oxacillin), cephalosporins (Cefalizin, Ceftriaxone, Cefoxitim) and macrolides (Azithromycin, Erythromycin). But it is better to use them and other antibacterial agents in the second trimester, and in the second half of pregnancy the range of antibiotics used can be expanded.
Aminoquinoline drugs Delagil or Plaquenil, which have anti-inflammatory, antiplatelet, antimicrobial, analgesic, antioxidant and other effects. Their administration to pregnant women is undesirable.
Iodine-containing preparations (solution potassium iodide) and iodine substitutes that promote the release of heparin by mast cells, which suppresses delayed-type hypersensitivity reactions, reduces thrombus formation and improves microcirculation.
Short courses of subcutaneous administration of Heparin or Fraxiparine (better) - in severe cases.
Antiallergic drugs (Fexofenadine, Loratidine).
Angioprotectors that dilate small vessels and increasing their tone, reducing swelling and permeability of their walls, improving rheological properties blood and microcirculation (Pentoxifylline, Curantil, Vazonit, T rental, etc.).
Vitamins “C” and “E”.
Glucocorticoid drugs (Prednisolone, Metipred, Dexamethasone, Diprospan) are indicated for erythema nodosum, especially associated with sarcoidosis, in the presence of an intense inflammatory process and in case of insufficient effectiveness of the treatment. They can be prescribed in low doses even at any stage of pregnancy.
Plasmapheresis or hemosorption - in case of particularly persistent and protracted course of the disease.

Local therapy

Local treatment is carried out with applications with Dimexin solution or Ichthyol solution, Dimexin gel in combination with Heparin, indovazin cream in combination with ointment or cream with corticosteroids - Beloderm containing betamethasone, Belogent (betamethasone with gentamicin), Belosalik (betamethasone with salicylic acid) .

After cupping acute manifestations In case of inflammation, it is possible to use physiotherapeutic procedures in the form of ozokerite applications, phonophoresis with liquid ointment (liniment) containing dibunol, with heparin, with lidase or hydrocortisone.

Inductothermy, magnetic therapy, ultra-high frequency currents, laser treatment, etc. are also used.

Unified standards and treatment regimens for erythema nodosum have not been developed. The main drugs currently used are antibiotics.

At the same time, their widespread use can contribute to the transition of an acute process to a chronic one. This is due to the lack of influence antibacterial agents and antibiotics for viruses and even many strains of bacteria.

On modern stage treatment of both idiopathic and secondary disease, unfortunately, is aimed primarily at reducing the severity of local inflammatory processes and reducing the duration of the disease.

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 heart complications.

If there are no exacerbations, the patient is prescribed local treatment. The affected areas are lubricated with Indovazin Ointment.

The drug "Curantil" is taken internally. Paracetamol is prescribed in small doses.

The drug "Diclofenac" is prescribed in injections.

An important condition for treatment during pregnancy is full compliance with the correct rest and work schedule. It is necessary to minimize the load on the lower limbs, but it cannot be completely eliminated, because the vessels of the limbs must always be in good shape.

A patient who contacts 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 to check for streptococcus. In order to exclude various infections, all kinds of blood tests are carried out.

Many amazing recipes can be learned from healers. Traditional medicine will suggest many ways to get rid of such a disease as erythema nodosum.

Treatment with folk remedies is adjuvant therapy. It should be combined with medication.

In this case, the results will be much better.

Traditional recipes:

Treatment of this pathology directly depends on the causes that caused it. The doctor prescribes therapy only after the patient has undergone full diagnostics. This is best done in a hospital setting. In acute cases, semi-bed rest is prescribed.

Treatment is carried out using various medications. These include:

Medicines from various groups are effective:

anti-inflammatory non-steroidal drugs;
in case of relapses or protracted inflammation, aminoquinoline drugs are prescribed;
antihistamines and corticosteroids.

If a disease is identified that provoked immunoinflammatory syndrome, then all efforts will be spent on eliminating it.

The extracorporeal method of plasmapheresis and the effect of laser on the blood helps to quickly reduce symptoms.
Home therapy includes hormonal ointments, compresses with dimexide or ichthyol solution. Diuretic herbs will help with swelling. Added to the diet legumes, dill, cumin.
Physiotherapy uses ultraviolet irradiation in erythemal doses, magnetic therapy, phonophoresis on the affected area using hydrocortisone.

If it is possible to determine the disease against which this nonspecific immunoinflammatory syndrome developed, then the main direction of treatment is to eliminate it.

At infectious etiology Antibacterial, antifungal and antiviral agents are used for treatment of the underlying disease.

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

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

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

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

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

It is not advisable to treat this disease at home, since the drugs used to treat it have a number of side effects and if used inappropriately, can cause damage to the patient’s health.

The criteria for the effectiveness of the therapy are the reverse development clinical signs diseases and a decrease or absolute disappearance of pathomorphological signs of inflammation of the vessels of the subcutaneous tissue.

Consequences and prognosis of erythema nodosum

Erythema nodosum is a disease that is dangerous due to its possible complications. Her acute phase often becomes chronic, the treatment of which is characterized by its complexity.

That is why one cannot hope that such a pathology can disappear without a trace on its own or through the use of traditional medicine recipes. Photos of patients chronically suffering from this disease are simply shocking with terrifying skin lesions not only of the lower extremities, but also of other parts of the body.

The only way to get rid of it is experienced doctor who established the correct diagnosis and prescribed the correct treatment.

In children, the pathology is less susceptible to treatment, so mandatory hospitalization is indicated. Women during pregnancy should also seek help immediately when the first symptoms are detected. Vascular pathology can cause heart complications.

Refusal timely therapy will lead to the development of a chronic form of pathology. Disturbances in the body can lead to the development of other diseases, including focal scleroderma.

We must also not forget that erythema nodosum is often the first evidence of other pathological processes occurring in the body. The sooner it is delivered accurate diagnosis, the higher the chances of complete recovery.

Prevention of erythema nodosum involves timely treatment any diseases, eliminating foci of infection in the body. To avoid unpleasant symptoms, you should pay enough attention to the immune system:

have a good rest;

regularly spend time on fresh air;

maintain proper diet.

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In which the vessels are affected locally, mainly in the lower extremities. People of both sexes and all ages suffer from this disease, but the majority of patients are people aged 20-30 years, and for every 3-6 sick women there is only one man. 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 of its occurrence, principles of diagnosis and treatment of this pathology. So, let's begin.

What is erythema nodosum

Erythema nodosum is a systemic disease of connective tissue affecting the skin and subcutaneous fat, 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 underlying pathology and is called secondary.

Causes and mechanisms of development of erythema nodosum

Taking certain medications can cause the development of erythema nodosum.

The etiology of primary erythema nodosum 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 nonspecific immunoinflammatory syndrome, the development of which can be triggered by many infectious and non-infectious factors. The main ones are presented below:

Non-infectious factors:

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

Infectious factors:

Streptococcal diseases are also one of the most common reasons 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 chemical substances, contained in medications, create a certain antigenic background in the body, which will not pay attention, and the genetically predisposed will give an immune response: a series of biochemical reactions and antibodies will begin to be produced. Often this pathology manifests itself precisely during pregnancy. Probably modified hormonal background also initiates the process of antibody formation, and possibly this moment due to the fact that during this period the woman’s body is significantly weakened and loses the ability to adequately resist negative factors.

Pathomorphological changes in erythema nodosum

As mentioned above, erythema nodosum is a nonspecific inflammatory process. First of all, small blood vessels of the lower extremities and lobules of adipose tissue along with interlobular septa located at the border of the dermis and subcutaneous fat 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 determined microscopically. The cells of the endothelium and other layers of the vascular wall swell, and inflammatory infiltrates (seals) consisting of lymphocytes and eosinophils appear in them. Hemorrhages occur in the surrounding tissues.

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

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

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

Clinical signs of erythema nodosum

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

Acute erythema nodosum. The pathognomonic symptom of this type of disease are 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 range in size from 0.5 to 5 cm, are dense to the touch, painful, slightly raised above the skin level, their boundaries are unclear due to some swelling of the surrounding tissues. The skin over the nodes is smooth, first reddish-pink, then bluish in color, and at the stage of resolution of the process - greenish-yellow. First, a small node appears, which grows quickly and, reaching its maximum size, stops growing. Sometimes the nodes are not only painful on palpation, but also spontaneously hurt, and pain syndrome can be of varying intensity, from weak to pronounced. 3-6 weeks after their appearance, the nodes disappear, leaving no scars or atrophic changes, only temporarily in their place peeling and increased pigmentation of the skin can be detected. Usually they 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.
Erythema nodosum migrans. It occurs without pronounced clinical manifestations, that is, subacutely. The patient feels weakness, pain in the joints of moderate intensity, body temperature rises to subfebrile levels (37-38°C), and the person is shivering. Then a node appears on the anterolateral surface of the leg. It is flat, dense, clearly demarcated from the surrounding tissues. The skin over the node is bluish-red. As the disease progresses inflammatory infiltrate migrates, resulting in the formation of a so-called plaque, which looks like a ring with a bright peripheral zone and pale color depression in the center. Later, several more small nodes may appear on both legs. After 0.5-2 months, the nodes regress.
Chronic erythema nodosum. It usually develops in women over 40 years of age who suffer from chronic infectious diseases or have. Symptoms of intoxication are extremely mild or completely 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 observed in the autumn-spring period, which is most likely due to the higher frequency of streptococcal infections at this time.

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

Diagnosis of erythema nodosum

With erythema nodosum, signs of an inflammatory process are detected in the blood.

Based on the patient’s complaints, medical history and life history, taking into account the data of an objective examination, the doctor will make a preliminary diagnosis of “erythema nodosum”. To confirm or refute it, a number of additional laboratory and instrumental studies will be required, namely:

Clinical blood test (it will determine the signs of an inflammatory process in the body: neutrophilic leukocytosis, ESR increased to 30-40 mm/h, that is, the erythrocyte sedimentation rate.
Blood test for rheumatoid tests (rheumatoid factor will be detected in it).
Bacterial culture from the nasopharynx (carried out to search for streptococcal infection).
Tuberculin diagnostics with 2 tuberculin tests (carried out in case of suspected tuberculosis).
Stool culture (if yersiniosis is suspected).
Biopsy of nodular formations followed by microscopic examination of the material taken (with erythema nodosum, inflammatory changes are detected 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 to subcutaneous fatty tissue).
Rhino- and pharyngoscopy (to search for chronic foci of infection).
X-ray of the chest organs.
Computed tomography of the chest organs.
Ultrasound of the veins and rheovasography of the lower extremities (to determine their patency and the severity of inflammation).
Consultations with specialists in related specialties: infectious disease specialist, otorhinolaryngologist, pulmonologist, phlebologist and others.

Of course, all of the above studies may not be prescribed for the same patient: their scope 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:

. Painful lumps on the skin with this disease resemble those with erythema nodosum, but they are located exclusively along the veins and have the appearance of tortuous strands. The limb is swollen, the patient complains of muscle pain. The general condition of the patient, as a rule, does not suffer; if the blood clot becomes infected, the patient notes weakness, increased body temperature, sweating and other manifestations of intoxication syndrome.
Erythema Bazin (the second name is indurative tuberculosis). Rashes with this disease are localized on the back of the lower leg. The nodes develop slowly, they are not characterized by signs of inflammation, and there is no noticeable separation from surrounding tissues. The skin over the nodes is red-bluish, but a change in its color as the disease progresses is not typical. Often the nodes ulcerate, leaving behind a scar. As a rule, women suffering from tuberculosis are ill.
Christian-Weber disease. This disease is also characterized by the formation of subcutaneous nodes, but they are localized in the subcutaneous fatty tissue of the forearms, torso and thighs, small in size, and moderately painful. The skin over the nodes is slightly hyperemic or not changed at all. They leave behind areas of fiber atrophy.
(). This is an acute infectious disease, the causative agent of which is β-hemolytic streptococcus of group A. Erysipelas debuts acutely with a rise in temperature to febrile values, severe weakness and other symptoms of general intoxication. After some time, burning, pain and a feeling of tension appear in the affected area of the skin, followed by swelling and hyperemia. The area of redness is clearly demarcated from adjacent tissues, its edges are uneven. Compaction is determined along the periphery. The area of inflammation rises slightly above the skin level and is hot to the touch. Blisters with contents of a serous or hemorrhagic nature, as well as hemorrhages, may form. A radical difference from erythema nodosum is inflammation of the lymphatic and regional vessels in erysipelas.

Treatment of erythema nodosum

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

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

(Movalis, Nimesulide, Celecoxib, Diclofenac);

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 has a certain type of disease course, then 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. Severe pain appears and 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:

The appearance of the described erythema may indicate that a disease such as tuberculosis is beginning or progressing in the body.
Also with sarcoidosis and nonspecific ulcerative colitis Erythema nodosum may appear.
Another cause of the disease may be infectious diseases(coccidioidomycosis, histoplasmosis, and yersiniosis).
In the same way, an inflammatory nodular process appears after taking certain medications. Because of them, an allergic reaction will begin, accompanied by erythema.
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 to histological examination fabrics.

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 a correct diagnosis

Acute erythema nodosum, features

In acute erythema nodosum, the lesions are located symmetrically on both legs or both forearms, and in rare cases they are 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 an increase in ESR, a high level of 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 resolves with 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

Most often, this type of 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, when chronic erythema the color of the skin above 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.

When 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 narrow specialists, and they carefully They will carry out diagnostics to identify the reasons due to which this disease manifested itself. The disease cannot be left to chance, since identifying and treating the disease is a mandatory measure. After all, the body may have a serious disease, 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 a direct negative effect on the fetus. The disease will affect the health of the expectant mother.

Because there is a suspicion that erythema will cause diseases of the cardiovascular system. In addition, stress may arise nervous soil, which will have a bad effect on the nervous system of the 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.

Another important criterion in the treatment of such a disease is adherence to sleep and rest patterns. 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, walks in the 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, 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 characterized by inflammation of the connective tissue between the skin and subcutaneous fat. It is also one of the manifestations of allergic vasculitis, in which the vessels are partially affected, often in the lower extremities. The age often affected by the disease is young: 15-30 years. The disease is equally common among both sexes of the population and is especially active during the winter-spring period.

Causes of the disease

photo shows erythema nodosum on the legs

Often this pathology manifests itself during pregnancy. During pregnancy, the female body is weakened and loses its ability to resist negative influences. There are many cases where the disease is a syndrome of the immune inflammatory process, but genetic disposition also plays an important role.

It usually occurs independently, but often occurs against the background of some pathology. Erythema nodosum can easily develop allergic nature, arising from contraceptives and sulfa drugs.

Among the causes of an infectious nature, the leading ones are:

tuberculosis bacillus;
streptococcal infection (tonsillitis, scarlet fever);
leprosy;
Hepatitis B;
coccidiosis;
psittacosis;
chlamydia;
, and etc.;
Lymphogranuloma venereum.

Non-infectious ones include:

sarcoidosis (most often the cause);
inflammation of the intestine (regional enteritis, ulcerative colitis);
Behcet's syndrome;
leukemia;
vaccination;
oncological formations of various types;
use of certain medications;
pregnancy.

The disease has 2 forms.

photo of erythema nodosum of the lower extremities

Acute course ring-shaped erythema worsens general state: the temperature rises, formations appear in the form of nodes on the legs and knees, rarely in the neck and face. The spots are painful to touch; they are red in color, turning into purple, and then brown and yellow. More than half of patients have joint inflammation.

In children, erythema occurs in severe form. The inflammatory process ends on its own after 7 weeks. The chronic course of this disease allows the exacerbation to leave the patient for a short time, but then the nodes move to new areas, that is, they migrate.

Types of erythema nodosum

When choosing therapy for effective treatment doctors differentiate the disease:

- is normal for the disease and is typical for newborns;
multiform develops after cold infections, nodes affect the oral mucosa, limbs, hands or palms;
talking about tick bite, a specific area of the bite is affected;
is a chronic form, the occurrence is due to the manifestation of an allergic reaction, poisoning, intoxication, the shapes of the nodes merge into rings;
nodular infectious occurs against the background of pathological conditions.

Symptoms of erythema nodosum

Classical external indicator diseases are rather dense nodes that form in the tissue under the skin or in parts of the dermis. The diameter of the nodes can reach 5 cm. On the upper part of the node the skin is smooth, the color is red, and the seal itself is slightly elevated above the level of the rest of the skin tissue. Having reached a certain size, the growth of nodes stops. The usual localization of nodes is the limbs, the surface of the legs. They are located symmetrically, but there is also a single character.
Painful sensations are expressed in different ways and are not necessarily sensitive only to palpation, but can also occur spontaneously. There is no itching or peeling. After about 5 days, the knots “unravel,” which indicates their greater compaction, and in this case, disintegration will not occur.
At the onset of the disease, there is usually an acute form, accompanied by fever and chills, weight loss, and malaise. More than half of patients complain of severe pain in the joints of the limbs and their stiffness in the morning. 1/3 of the sick suffer from arthritis: the joint area swells and turns red, and the local temperature is elevated. General symptoms appear several days before the skin elements.
In less than a month, the nodes are resolved. Hyperpigmentation and, less commonly, peeling may occur in these areas for a short period of time. However, along with skin formations Articular syndrome also disappears.

To diagnose erythema nodosum of the lower extremities in laboratory conditions A dermatologist can. At acute period clinical analysis blood will show neutrophilic leukocytosis. Nasopharyngeal culture may reveal streptococcus. In cases of severe joint syndrome, a visit to a rheumatologist is indicated to check the blood for rheumatoid factor.

To find out accompanying inflammation chronic disorders a study by a pulmonologist may be necessary, vascular surgeon, an infectious disease specialist, and will also have to undergo an ultrasound scan of the veins and rheovasography of the lower extremities.

Treatment of erythema nodosum on the legs

Medicines from various groups are effective:

anti-inflammatory non-steroidal drugs;
in case of relapses or protracted inflammation, aminoquinoline drugs are prescribed;
antihistamines and corticosteroids.

If a disease is identified that provoked immunoinflammatory syndrome, then all efforts will be spent on eliminating it.

The extracorporeal method of plasmapheresis and the effect of laser on the blood helps to quickly reduce symptoms.
Home therapy includes hormonal ointments, compresses with dimexide or ichthyol solution. Diuretic herbs will help with swelling. Legumes, dill, and cumin are added to the diet.
Physiotherapy uses ultraviolet irradiation in erythemal doses, magnetic therapy, phonophoresis on the affected area using hydrocortisone.

The effectiveness of any therapy will be influenced by the result of treatment of the pathology that caused the occurrence of annular erythema. Great inconvenience for the doctor arises when treating a disease during pregnancy due to the fact that most drugs that can cure the disease are contraindicated.

In difficult cases and in the absence of tuberculosis, glucocorticoid and hormonal drugs are prescribed.

Possible complications

The disease is not dangerous provided that it is not a companion to another pathology. It can appear long before the underlying disease manifests itself. Full examination on early stage erythema nodosum and identifying its cause will help the necessary treatment give a quick and positive result.

In two cases out of ten, a relapse occurs, but there is no threat to life for the patient. The progression of the disease does not harm human body and does not always turn into chronic stage diseases. Therapeutic prognosis is completely positive in the absence of pathological forms.

Children and pregnant women

The child has clinical picture almost the same as in adults. But there are still differences. Detection of this disease in children in many cases indicates the presence of tuberculosis in the body. The disease is accompanied by fever, chills and joint pain. The nodes appear on the thighs and lower extremities, are swollen and small in size.

If tuberculosis is not detected, therapy includes aminocaproic acid, reopirin, calcium gluconate, brufen.

For inflamed lesions, use Vishnevsky ointment or acemin. B vitamins and rutin are added. The dynamics of the disease enters a positive phase during the first week of treatment. In case of relapse, a thorough diagnosis is prescribed for tumors, rheumatism, and stomach diseases.

During pregnancy, many drugs are contraindicated and the treatment process becomes more complicated. Treatment usually ends without medication, including bed rest and elastic bandages for fixing nodes.

If there are concomitant pathologies, home isolation will not bring the desired results. If the benefits of unwanted drugs outweigh the risk for the pregnant woman, they are still prescribed in minimal doses.

Taking preventive measures:

carefully monitor the vascular system;
If signs of varicose veins appear, undergo an examination;
avoid contact with allergens;
treat chronic diseases.