Erythema nodosum

Erythema nodosum

Erythema nodosum – dermatosis of unknown etiology, characterized by damage to the vessels of the skin; manifested by the appearance in the dermis or subcutaneous tissue on the legs and thighs of dense painful nodes. Women aged 20-30 are most often affected. Genetic aspects. Inherited form (MIM 132990.91, erythema nodosum familial). Risk factors

    • Infectious diseases
    • Deep mycoses
    • Sarcoidosis
    • Taking drugs (sulfonamides, oral contraceptives, bromides)
    • Ulcerative colitis
    • Crohn’s disease.

 

Clinical picture

    • Raised, dense, bright red (with a subsequent color change to purple-yellow) nodes 1-1.5 cm in diameter, traditionally localized on the anterior surfaces of the legs, but can be located on almost any part of the body
    • Fever, malaise, chills
    • Joint pain
    • Adenopathy of the hilar lymph nodes of the lungs
    • Episcleral rashes are possible.

 

Research methods

    • Blood test: increased ESR, moderate leukocytosis
    • Skin test for mycobacteria according to indications
    • Chest x-ray for presence of hilar lymphadenopathy or infiltrates
    • Deep skin biopsy (not often indicated).

 

Differential Diagnosis

    • Thrombophlebitis
    • Cellulite
    • nodular vasculitis
    • Weber-Christian disease
    • SLE
    • Granulomatous sarcoidosis
    • Lymphoma.

 

Treatment

    • NSAIDs
    • Aspirin (acetylsalicylic acid) 325 mg up to 8-12 r / day. It is recommended to systematically determine the content of the product in the blood serum (side effects often appear at concentrations of 30 mg% and above)
    • Indomethacin 75-150 mg/day in 3 divided doses
    • Naproxen 500-1000 mg/day in 2 divided doses
    • NSAIDs can cause dyspepsia, gastrointestinal bleeding, fluid retention in the body, are contraindicated in gastric ulcers in the acute stage, are used with caution in kidney disease, diabetes mellitus, and heart failure.
    • If a streptococcal infection is suspected, long-term antibiotic therapy is recommended.
    • Potassium iodide 40-900 mg every day in 2-3 doses.
    • With single nodes – the introduction of triamcinolone acetonide (2.5-5 mg / ml) into the affected area.
    • Glucocorticoids – only in very severe cases.

Current and forecast. The duration of the disease is 6-12 weeks. In 12-14% of cases, it is recurrent, with remissions lasting several years. Relapses are traditionally associated with streptococcal infection, pregnancy, oral contraceptives. Synonym. Erythema nodosa ICD L52 Erythema nodosum

Leave a Comment

Your email address will not be published. Required fields are marked *