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

The condition of the skin is not only a concern for women.

Everyone experiences anxiety when some kind of rash or other changes appear on their body. One problem requiring special attention is erythema nodosum. What is erythema

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

The pathological process is caused by infections, allergies to drugs, may indicate the development of another disease:

sarcoidosis
bowel disease
diseases associated with tumors or infections

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

Symptoms

First, there is a deterioration in the general condition. Then appear on the knees, shins, a little less often on the neck and face, nodes that hurt when touched. They have a reddish tint, changing first to purple, and then acquire a brown and yellowish color. Most sick people have inflammation of the joints.

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

Which doctor should be contacted

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

Features of the treatment of children

Basically, the symptoms of the disease have a similar picture in adults and children. However, some specificity is still observed. In children, illness is often considered the first sign of a TB infection.

Often it is accompanied by fever, increased ESR, as well as chills and joint pain. Sometimes there is an upset stomach. In preschool children, erythema nodosum develops as a result of an allergic reaction to a tuberculosis infection.

In children, the pathology is represented by acute inflammatory painful nodes on the thighs and shins, forearms. The nodes are tense and edematous, without clear boundaries, rising above the skin. Their coloration resembles bruises.

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

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

Treatment of erythema nodosum during pregnancy

The disease is 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 do not have any negative impact.

In case of failures in the activity of the heart, the doctor will recommend that the pregnant woman lie down for preservation. In the absence of complications, erythema nodosum in pregnant women is treated with ointments. Indovazin, Deep Relief and Diclofenac. Also shown is the reception Chimes, paracetamol and aspirin in small doses. Most effective in treating erythema nodosum during pregnancy indovazin.

It is desirable during this period to reduce the load on the lower limbs. Bed rest is prescribed, alternating with small motor loads. This is due to the fact that pregnant women do not get rid of the disease after childbirth. Erythema nodosum flows into a chronic form, manifesting itself as interseasonal relapses when climatic conditions change.

How and how to treat erythema nodosum?

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

Antibiotics recommended (Erythromycin, Tseporin, Kefzol), anticoagulants, angioprotectors, desensitizing agents. In the treatment of erythema nodosum of the lower extremities, ultrasound therapy is effective. It is also desirable for the patient to undergo a course of laser therapy, magnetotherapy, inductothermy.

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

Folk remedies in the treatment of nodular (nodular) erythema play an important role. 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 vegetable raw materials, mix in equal proportions with melted lard or castor oil. Simmer the mixture in a water bath for about an hour, then filter it 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 with folk remedies, you can prepare an ointment from 100 g dry arnica roots which are ground in advance in a mortar. Mix the powder with pork fat. Then, for about 3 hours, boil the composition over low heat, not forgetting to stir. After cooling, treat the skin three times a day.

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

The effect in the treatment of the acute form of the disease is achieved by choleretic agents prepared from medicinal berries and herbs. Leaves of birch, lemon balm, lingonberry, mint, immortelle and yarrow mix, collect one large spoonful of herbs and brew in half a liter of boiling water. Infuse 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 in the need to promptly improve the body. Erythema nodosum on the legs treatment

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

In the medical literature, you can also find the name erythema nodosum. Experts attribute pathology to varieties 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, pathology is faced by young people aged 20-30 years. Statistics show that women develop the disease more often. Exacerbation in most cases occurs in the winter-spring period.

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

Causes and mechanisms of development of erythema nodosum

The body's immune response

With regard to the mechanisms of the development of the disease, most authors give the main importance to the hypothesis of an immune response of the body of an immediate or delayed type in response to exposure to bacterial, viral or other provoking antigens.

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

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

Causes of erythema

According to the research of 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 are formed with such diseases:

erysipelas of the skin;
angina and otitis;
pharyngitis in acute form;
streptoderma;
rheumatoid arthritis;
inflammation of the bladder.

The defeat of the vascular wall develops in such conditions:

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

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

The use of certain drugs can also lead to the development of this pathology. These funds include:

antibacterial drugs;
sulfonamides;
oral contraceptives.

The deep roots of erythema nodosum have been tried for a long time to detect, but to no avail.

For the sake of justice, it should be said that even today the cause of the disease has not yet been fully elucidated.

Only some of the factors that provoke the appearance of erythema nodosum are considered.

The risk group includes pregnant women, and women taking contraceptive, hormonal drugs.

European and American doctors have found a link between erythema nodosum and:

yersiniosis;
histoplasmosis;
sarcoidosis;
tuberculosis;
streptococcal infection.

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

Doctors have proven that erythema nodosum manifests itself most often in women prone to vascular diseases of the lower extremities:

thrombophlebitis;
varicose disease.

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

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

Usually, doctors examine for erythema nodosum:

diseases of the gastrointestinal tract;
lupus erythematosus;
tuberculosis.

Be sure to assign cultures from the uterine pharynx to identify streptococcus.

Sometimes, erythema nodosum is an independent disease.

In this case, the search 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 a test of tuberculosis.

The acute phase of erythema is manifested by red spots, and only then, the color of age spots can change depending on the form and stage of attenuation.

Sick people have:

chills;
pain in the joints;
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 often, the root cause is coccidioidomycosis, yersiniosis, inguinal lymphogranulomatosis, trichophytosis.

In addition, drug sensitization may be the cause.

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

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

Nodules on the skin can develop as a side effect of drug therapy. Often, erythema nodosum appears after vaccination or antibiotics.

People suffering from oncological 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 family cases of erythema nodosum. Of great importance is hereditary predisposition to the development of the pathological process. If parents suffer from the disease, there is a risk of inflammation in the child.

Prevalence

Erythema nodosum occurs in 5-45% of the population, especially at a young age. As a result of epidemiological studies, it was found that in different regions the percentage of morbidity differs significantly and largely depends on the predominance of a particular pathology characteristic of a particular area.

However, complete statistical data on the prevalence of this disease is not enough. It is only known that in the UK in 1 year per 1000 population 2-4 cases are recorded.

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 so far a specific etiological factor has not been established, and the frequency of chronic forms remains quite high.

There are no differences in the incidence of the disease between the urban and rural populations, as well as between the sexes of adolescence. However, after puberty, girls and women are affected 3-6 times more often than boys and men.

It is generally accepted that the pathology develops mainly against the background of other diseases, of which the most common is sarcoidosis. Although persons 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 age period. Often, after a chest x-ray examination, patients who applied with a clinical picture of erythema nodosum were found to have sarcoidosis.

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

pictured erythema nodosum on the legs

Often this pathology shows itself during the course of pregnancy. The female body during the period of gestation is weakened and loses its strength of resistance to negative influences.

Many cases are recorded when the disease is a syndrome of the immune inflammatory process, but the genetic disposition also plays an important role.

Types of erythema nodosum

Rashes can develop in adults as an independent disease. In this case, the pathology is primary.

If inflammation of the vessels 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 the lower extremities.

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

Infectious erythema. 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, may be accompanied by pain in the throat, joints. Nodes are formed not only on the limbs, but also on the oral mucosa, in the genital area.
Annular erythema. The disease is classified as chronic. Pathology can develop against the background of allergic reactions, a prolonged illness of an infectious nature. Round nodules eventually merge into rings.
migratory erythema. Pathology is manifested due to a tick bite.

Toxic erythema is a disease that develops in a child in the first days of life. Small red seals appear on the baby's body. After a few days, the rash goes away on its own. No special treatment is required.

The disease can manifest itself in an 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 nodosa, the treatment of which is somewhat different. From the photo 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.

There are the following types of erythema nodosum:

Symptoms of the disease

At the beginning of the disease, as a rule, patients feel unwell, have a high fever, 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 suspect that something is disturbing, because the symptoms of the disease correspond to those of the 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 most anterior surface of the lower 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 visible 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 have an elevated temperature, in diameter from 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 shade, such a process can be observed during the formation of a bruise.
nodular formations grow very quickly, but reach a certain size. Patients feel pain not only during palpation, but also when walking, lifting weights and even light physical exertion.

The symptomatology of the disease is quite specific and is diagnosed by an experienced specialist quickly and accurately. It is important that the patient pays attention to skin changes. They are easily confused with the usual bruise after a blow or injury: the appearance is accompanied by blueing, which disappears after 2-3 weeks. The main differences from mechanical damage to blood vessels are the mass nature of formations and the absence of 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;
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 education is compacted as in the development of a hematoma.

Acute erythema nodosum

It is considered a normal classic form of the 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 foci can merge into single large spots. The complete absence of itching is characteristic, the pain symptom can manifest itself without external influence, and the spots will turn very red.

Acute erythema nodosum often manifests itself against the background of infectious diseases: SARS, tonsillitis and similar. The initial period is characterized by high body temperature and flu-like symptoms during the onset of the disease: aching joints, muscle pain, general weakness.

Individually, inflammation of the joints is possible, as with arthritis, severe swelling. Granulomas resolve spontaneously within 3 to 6 weeks, depending on the severity of the case.

The primary infectious disease should be treated, erythema is a side symptom.

- Solitary red painful nodules that rise above the surface of the skin; are located on the front surface of the legs, occasionally on other parts of the body. - Weakness, fever and arthralgia are possible, 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:

Sharp.
migrating.
Chronic.

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

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

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

Diagnostics

For a qualified dermatologist, it will not be difficult to make a correct diagnosis already with a visual examination of the 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 walls of blood vessels. The following methods 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.
Bakposev from the nasopharynx. The study allows you to identify the presence of streptococcal infection in the body.
Tuberculin test. The study is carried out if a patient is suspected of having tuberculosis. For the same purpose, the patient needs to do a chest x-ray.
Blood test for platelets. An increase in the indicator indicates the development of vascular pathology.
Biopsy of one of the nodular formations. The study is carried out in the event that 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 carried out:

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

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

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

A mandatory study is X-ray or, more reliably, computed tomography of the chest organs. The presence in the results of the study 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 in the postpartum period. Löfgren's syndrome is a type of mild pulmonary sarcoidosis that requires appropriate therapy.

What tests need to be done?

General blood tests are uninformative. They can only testify (not always) to the presence of an inflammatory (accelerated ESR) and / or allergic (increase in the number of eosinophils) process.

To some extent, analyzes 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 a recent inflammatory streptococcal infection.

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

Although this disease 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 immediately diagnosed on examination. The patient gives a swab from the pharynx, which is checked for streptococcus.

It is also necessary to make an x-ray of the lungs, which allows to exclude such causes of the disease as tuberculosis and sarcoidosis. Sometimes, to confirm the diagnosis, the patient donates feces, which are examined for the presence of Yersinia pathogens.

This erythema disease is characterized by an increased erythrocyte sedimentation rate. 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 the differential diagnosis, which allows to exclude diseases such as vasculitis

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

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

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

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

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

Erythema treatment

In the diagnosis of erythema, doctors recommend performing basic blood tests and a serological examination for the presence of viral antigens. For the final diagnosis of the disease, a sample may be taken, which is subjected to histological examination.

Erythema often takes a long time to heal. It must be performed by a qualified dermatologist. It is necessary to eliminate factors that can increase the risk of the disease (foci of infection and medications). Systemic therapy should be used for a sufficiently long time.

Therapeutic treatment is determined individually for each patient. This is not possible without inspection. It 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 an X-ray examination of the lungs in order for the attending physician to rule out the development of pathologies such as tuberculosis and sarcoidosis.

It is also necessary to take a smear for the presence of streptococcal infection in the body. Additional blood tests are needed to rule out other infections.

- 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, zirtek, suprastin, diazolin) are taken.

Depending on the test results, antibiotics may be prescribed.

Self-treatment of erythema is strictly prohibited, since medicinal preparations 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 specialist doctor.

A person with nodular erythema is prescribed mandatory bed rest.

Extremely popular treatments such as physiotherapy:

diathermy;
warming compresses on the lower leg;
phonophoresis.

People who have had any form of erythema nodosum are advised to regularly visit seaside resorts (at least once a year), dosed walks, avoid alcohol and smoking. If possible, avoid cold places, do not get a standing job and do not lift heavy things.

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

Also, much attention is paid 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 the clinical manifestations of the disease, patients are advised to adhere to preventive measures for at least a year. If possible, avoid long walks, bruises, hypothermia and nervous breakdowns.

To improve blood circulation and strengthen the walls of blood vessels, doctors may prescribe supportive treatment. Sulfur and carbonic baths received good reviews.

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

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

It is necessary to provide rest for the lower extremities. To improve the outflow of blood from the inflamed areas of the leg, it is recommended to fix it in an elevated position.

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

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

Compresses with Dimexide will help to quickly remove unpleasant symptoms. However, it is impossible to use an anti-inflammatory agent in its pure form, otherwise you can get a burn.

The course of therapy is 10 days.

Medicines for erythema nodosum - gallery

Physiotherapy treatments

After stopping the acute inflammatory process, when the patient's body temperature returns to normal, the following therapies can be used to speed up the process of restoring damaged areas:

UFO. Ultraviolet rays have a tonic and immunostimulating effect.
Phonophoresis. With the help of ultrasound, drugs are injected into the damaged areas.
Magnetotherapy. Due to the influence of a magnetic field, the regeneration of damaged vessels is accelerated, and blood flow is stimulated.
Laser therapy. Laser radiation has a vasoconstrictive and immunostimulating effect.

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

Alternative methods of treatment of erythema nodosum

By agreement with the doctor, conservative therapy can be supplemented with traditional medicine. Many of them show high efficiency. However, they should never be used on their own.

Aloe and honey

A few fresh aloe leaves 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 with a tendency 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.

In the presence of a pronounced picture of the disease, it is necessary to comply with bed rest for a week, which reduces the swelling of the lower extremities and the intensity of pain.

Medical therapy

In moderately severe and mild forms of erythema nodosum, treatment begins with the use of one of the drugs from the class of NSAIDs (non-steroidal 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 desirable not to prescribe to pregnant women in the first trimester. The safest for the fetus are antibiotics of the 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 appointment to pregnant women is undesirable.
Iodine-containing preparations (potassium iodide solution) and iodine substitutes that promote the release of heparin by mast cells, which suppresses delayed-type hypersensitivity reactions, reduces thrombosis and improves microcirculation.
Short courses of subcutaneous injection of Heparin or Fraxiparine (better) - in severe cases.
Antiallergic drugs (Fexofenadine, Loratidine).
Angioprotectors that dilate small vessels and increase their tone, reduce swelling and permeability of their walls, improve the rheological properties of blood and microcirculation (Pentoxifylline, Curantil, Vasonite, Trental, etc.).
Vitamins "C" and "E".
Glucocorticoid agents (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 - with a particularly persistent and protracted course of the disease.

Local therapy

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

After stopping the acute manifestations of the inflammatory process, it is possible to use physiotherapeutic procedures in the form of applications of ozocerite, phonophoresis with a liquid ointment (liniment) containing dibunol, with heparin, with lidase or hydrocortisone.

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

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

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

At the present stage, the treatment of both idiopathic and secondary diseases, unfortunately, is mainly aimed 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 complications on the heart.

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

Inside take the drug "Kurantil". In small doses, the drug "Paracetamol" is prescribed.

The drug "Diclofenac" is prescribed in injections.

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

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

Many amazing recipes can be gleaned from healers. Traditional medicine will tell you many ways to get rid of such an ailment as erythema nodosum.

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

In this case, the results will be much better.

Folk recipes:

The treatment of this pathology directly depends on the causes that caused it. Therapy is prescribed by the doctor only after the patient has been fully diagnosed. It is best to do this in a hospital setting. In the acute form, a semi-bed rest is put.

Treatment is carried out with the help of various drugs. These include:

Effective drugs of various groups:

anti-inflammatory nonsteroidal drugs;
with relapses or a protracted process of inflammation, aminoquinoline drugs are prescribed;
antihistamines and corticosteroids.

If a disease that provoked an immunoinflammatory syndrome is detected, then all forces will go to eliminate it.

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

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

With an infectious etiology of the underlying disease, antibacterial, antifungal and antiviral agents are used for the purpose of treatment.

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

non-steroidal 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 often recurrent or protracted forms of the disease;
antihistamines (Suprastin, Loratadin, Cetirizine).

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

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

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

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

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

Consequences and prognosis of erythema nodosum

Erythema nodosum is a disease dangerous for its possible complications. Its acute phase often turns into a chronic one, the treatment of which is characterized by its complexity.

That is why it is impossible to hope that such a pathology can disappear without a trace by itself or by using traditional medicine recipes. Photos of patients chronically suffering from this disease are simply shocking with horrific skin lesions not only of the lower extremities, but also of other parts of the body.

Only an experienced doctor who has established the correct diagnosis and prescribed the correct treatment will help get rid of it.

In children, the pathology is less treatable, therefore mandatory hospitalization is indicated. Women should also seek help immediately when the first symptoms are detected during pregnancy. Pathology of blood vessels can cause complications in the heart.

Refusal of timely therapy will lead to the development of a chronic form of pathology. Violations 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 an accurate diagnosis is made, the higher the chances of a complete cure.

Prevention of erythema nodosum consists in the timely treatment of any diseases, the elimination of foci of infection in the body. In order not to encounter unpleasant symptoms, it is worth paying enough attention to the immune system:

fully rest;

regularly spend time outdoors;

follow the correct diet.

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

What is erythema nodosum

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

Causes and mechanisms of development of erythema nodosum

Taking certain medications can cause the development of erythema nodosum.

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

Non-infectious factors:

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

Infectious factors:

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

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

Pathological changes in erythema nodosum

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

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

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

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

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

Clinical features of erythema nodosum

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

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

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

Diagnosis of erythema nodosum

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

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

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

Differential diagnosis of erythema nodosum

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

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

Treatment of erythema nodosum

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

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

(Movalis, Nimesulide, Celecoxib, Diclofenac);

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

Erythema nodosum is characterized by reddish-blue patches

Types of nodular erythema

Such an ailment as erythema nodosum has several varieties, depending on the form of the disease and progression:

chronic erythema nodosum;
acute erythema nodosum.

If the acute form has a certain type of course of the disease, then chronic nodular erythema is divided into subspecies:

erythema nodosum migrans;
superficially infiltrative.

Erythema migrans

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

Erythema superficially infiltrative

With superficial infiltrative erythema, the affected areas increase to large sizes, body temperature rises, hyperemia in the focus. There is severe pain, swelling of the joints. ESR rises in the blood.

Erythema can lead to fever and severe pain

What causes erythema nodosum. The reasons

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 begins or progresses in the body.
Also, with sarcoidosis and ulcerative colitis, nodular erythema may appear.
Another cause of the disease can be infectious diseases (coccidioidomycosis, histoplasmosis, and yersiniosis).
Similarly, 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 skin areas.

Erythema nodosum symptoms

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

Diagnosis of erythema nodosum

First of all, the doctor conducts a survey of 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 tissues.

To exclude systemic diseases appoint:

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

An X-ray of the lungs is essential for a correct diagnosis.

Acute nodular erythema, features

In acute erythema nodosum, the foci are located symmetrically on both legs or on both forearms, 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, there is pain in the lesions. The contour of the inflamed skin is shapeless, blurry. At the beginning of the disease, the node is small in size, but it quickly increases. After the seal has reached its maximum size, the growth of the node stops.

After about a month, the nodes dissolve, leaving pigmented areas of the skin and dark spots in their place. Over time, there will be no trace of erythema nodosum. No relapse has been observed.

There is no itch. In the blood test, an increase in ESR, a high level of leukocytes is determined, which indicates an inflammatory process in the human body.

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

Migratory form of erythema nodosum, features

Erythema migrans nodosum resolves with a subacute course. The patient develops pain in the joints, general malaise, chills, fever. The lesion that appeared on the shin is flat and dense to the touch. The skin over the nodule has a bluish-red color. After a few weeks, softening is felt in the center at the site of the node. Then, near the existing foci, several small nodules may appear, symmetrically.

Chronic nodular erythema, 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 migrating erythema. But unlike the above species, with chronic erythema, the skin color over the nodules does not change. With an exacerbation, the symptoms of the disease manifest themselves more strongly.

The 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.

With erythema nodosum, large joints are affected. In the area of the joints, swelling, hyperemia is noted. In rare cases, the joints of the hands and feet are affected. After the nodules begin to dissolve, the joints also recover.

Streptococcal infections cause an 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 directed to its elimination.

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

With primary erythema, the patient is prescribed:

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

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

Physiotherapy is also prescribed, which is effective for erythema nodosum. UVR is used 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 this should be reported to the gynecologist, in whom the pregnant woman is registered. Then he will refer the pregnant woman to narrow specialists, and they will carefully conduct a diagnosis in order to identify the reasons due to which this disease manifested itself. It is impossible to let the disease take its course, since the identification and treatment of the disease is a mandatory measure. After all, there can be a serious disease in the body, such as tuberculosis or gastrointestinal diseases. If the cause is confirmed, then 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, nervous stress can occur, which will adversely affect the nervous system of the mother and child. It is not uncommon for erythema foci to resolve by the beginning of the third trimester of pregnancy.

When nodular erythema appears, it is necessary to constantly be observed by a doctor

Treatment of nodular erythema during treatment

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

paracetamol (in tablets);
oral aspirin tablets and diclofenac injections to relieve the inflammatory process;
ointment indovazin, to lubricate the affected areas of the skin.

Another important criterion in the treatment of such an ailment is the observance of sleep and rest. It is also necessary to minimize the load on the vessels of the lower extremities. To strengthen the vessels, a period of alternation is prescribed: sleep, rest, walks in the fresh air and bed rest. The method of how to treat erythema nodosum should be determined by a rheumatologist and gynecologist who is registered with the pregnant woman. After all, if the treatment is incorrectly prescribed and incorrectly performed, then erythema can become chronic. And in this case, it is impossible to avoid exacerbations of the disease in the spring and autumn, as well as with a decrease in immunity, and in subsequent pregnancies.

Which doctor to contact with such an ailment

If compacted nodules have appeared under your skin, and you cannot determine what it is, what kind of ailment 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 harder. 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 on 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

pictured erythema nodosum on the legs

Often this pathology shows itself during the course of pregnancy. The female body during the period of gestation is weakened and loses its strength of resistance to negative influences. Many cases are recorded when the disease is a syndrome of the immune inflammatory process, but the genetic disposition also plays an important role.

Usually it occurs on its own, but it often manifests itself against the background of any pathology. Erythema nodosum can easily be allergic in nature, arising from contraceptives and sulfa drugs.

Among the causes of an infectious nature are in the lead:

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

From non-infectious emit:

sarcoidosis (most often the cause);
intestinal inflammation (regional enteritis, ulcerative colitis);
Behçet's syndrome;
leukemia;
vaccination;
oncological formations of a different nature;
the use of certain medications;
pregnancy.

The disease has 2 forms.

photo of nodular erythema of the lower extremities

The course of the acute form of annular erythema worsens the general condition: 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, turning purple, and then brown and yellow. More than half of patients have joint inflammation.

In children, erythema is severe. The inflammatory process ends by itself 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 a therapy for effective treatment, physicians differentiate the disease:

- is the norm for the disease, typical for newborns;
multiform develops after colds, nodes affect the oral mucosa, limbs, hands or palms;
speaks of a tick bite, a specific area of \u200b\u200bthe bite is affected;
is a chronic form, the occurrence is due to the manifestation of an allergic reaction, poisoning, intoxication, the forms of the nodes merge into rings;
nodular infectious occurs against the background of pathological conditions.

Symptoms of erythema nodosum

The classic external indicator of the disease is rather dense nodes formed in the fiber under the skin or in 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 the nodes is the limbs, the surface of the legs. They are located symmetrically, but there is also a single character.
Pain sensations are expressed in different ways and are not necessarily sensitive only to palpation, but can also occur spontaneously. There is no itching and peeling. After about 5 days, the knots “untie”, which indicates their greater compaction, and in this case, disintegration will not occur.
At the onset of the disease, an acute form is usually present, accompanied by fever and chills, weight loss, and malaise. More than half of patients complain of severe pain in the joints of the extremities and their stiffness in the morning. 1/3 of the diseased is exposed to arthritis: the area of the joints swells and turns red, the local temperature is elevated. General symptoms appear a few days before skin lesions.
In less than a month, knots are resolved. In these places, hyperpigmentation and less often peeling may occur for a short time. However, along with skin formations, the articular syndrome also disappears.

A dermatologist can diagnose erythema nodosum of the lower extremities in the laboratory. In the acute period, a clinical blood test will show neutrophilic leukocytosis. Nasopharyngeal cultures may reveal streptococcus. With pronounced joint syndrome, a visit to a rheumatologist is indicated to check the blood for rheumatoid factor.

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

Treatment of erythema nodosum on the legs

Effective drugs of various groups:

anti-inflammatory nonsteroidal drugs;
with relapses or a protracted process of inflammation, aminoquinoline drugs are prescribed;
antihistamines and corticosteroids.

If a disease that provoked an immunoinflammatory syndrome is detected, then all forces will go to eliminate it.

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

The effectiveness of any therapy will be influenced by the result of the treatment of the pathology that caused the occurrence of erythema annulare. Great inconvenience for the doctor arises in the treatment of the 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 of another pathology. It can manifest itself long before the underlying disease manifests itself. A complete examination at an early stage of erythema nodosum and identifying its cause will help the right treatment to 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 course of the disease does not harm the human body and does not always go into the chronic stage of the disease. Therapeutic prognosis is completely positive in the absence of the presence of pathological forms.

Children and pregnant women

In a child, the clinical picture is almost the same as in adults. But there are still differences. The 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 pain in the joints. Nodes appear on the thighs and lower extremities, are swollen and small in size.

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

For inflamed foci, Vishnevsky ointment or acemin is used. Vitamins of group B, 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, stomach diseases.

During the period of gestation, many drugs are contraindicated and the treatment process becomes more complicated. Usually stop at treatment without medication, including bed rest and elastic bandages to fix the knots.

In the presence of concomitant pathologies, home isolation will not bring the desired results. If the benefits of unwanted drugs outweigh the risks to the pregnant woman, they are still prescribed in minimal doses.

Taking preventive measures:

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