Erythema nodosum on the legs often breaks out. What is erythema nodosum of the lower extremities and how to treat it in children and adults? Types of erythema nodosum

Chronic infections (tonsillitis, pyelonephritis, sinusitis) and diseases of allergic origin can also cause the development of this disease. Erythema often affects people with diseased blood vessels.

It can also result from:

tuberculosis;
sarcoidosis;
leukemia;
lymphogranulomatosis;
streptococcal infection (scarlet fever, streptoderma);
venous diseases;
fungal infection;
rheumatoid arthritis;
lupus erythematosus;
nonspecific ulcerative colitis;
less often - cancer or leprosy.

Factors contributing to the development of the disease in pregnant women are disturbances in the functioning of the endocrine organs, blood stagnation in the lower extremities, prolonged exposure to cold, seasonal weather changes, and hypertension.

With this pathology, the vessels located in the skin and subcutaneous layer become inflamed. Quite painful nodes up to 5 centimeters in size form on the legs. The number of such formations can reach several dozen.

On a note. According to statistics, this disease is more often found in women who are preparing to become mothers or taking hormonal contraceptives.

The pathology can develop as an independent disease, but more often erythema nodosum on the legs progresses against the background of existing problems in the body.

Causes and symptoms

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

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

Such reasons include the following.

Sometimes erythema nodosum on the legs can appear as a reaction of the body to certain medications: sulfonamides, antibiotics, contraceptives, iodine and others.

The risk of erythema nodosum of the lower extremities may increase during pregnancy. Some role in the appearance of this pathology is played by hereditary predisposition.

Erythema nodosum develops as a result of granulomatous or allergic inflammation of the vessels of the subcutaneous tissue. It mainly affects the blood vessels in the legs. Belongs to a type of vasculitis.

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

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

Erythema nodosum is a lesion of the lower extremities that is inflammatory in nature. Most often, inflammation covers symmetrical areas of the legs. The disease can be diagnosed during a dermatological examination. It is also important for doctors that the patient undergoes laboratory tests, has an x-ray of the lungs, and receives a report from a pulmonologist and rheumatologist.

During therapy, doctors strive to eliminate foci of infection, for which they prescribe antibiotic therapy.

Treatment also involves the use of anti-inflammatory therapy, extracorporeal hemocorrection, ILBI and physiotherapy. Erythema nodosum is classified as a type of allergic vasculitis. However, its difference lies in the local nature of vascular damage.

Causes of the disease:

Angina;
Scarlet fever;
Pharyngitis;
Streptoderma;
Otitis;
Cystitis;
Arthritis;
Tuberculosis.

The main reasons for the progression of erythema nodosum in humans have not yet been precisely established. Scientists suggest that the hereditary factor plays an important role in the development of this pathology.

They also note that in some clinical situations, erythema nodosum is a nonspecific immunoinflammatory syndrome. Infectious and non-infectious causes can provoke the manifestation of pathology.

These are various infectious causes: streptococcal infections (tonsillitis, scarlet fever), tuberculosis, yersiniosis, lymphogranuloma venereum, leprosy, histoplasmosis, coccidiosis. In a word, everything that we call “chronic foci of infections.”

Non-infectious: sarcoidosis (a fairly common cause of erythema), nonspecific ulcerative colitis.

Deep vasculitis of the lower extremities is an independent nosological form, but this disease often begins to develop against the background of the presence of systemic pathologies, including primary tuberculosis, sarcoidosis, leprosy (leprosy), lymphogranuloma venereum, yersiniosis, tonsillitis, rheumatism and bacterial (streptococcal) infections.

Erythema nodosum can occur in patients of any age, but the main risk group is young women aged 20 to 30 years.

Classification

When making a diagnosis, the doctor carries out a differential diagnosis of erythema.

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

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

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

It is customary to distinguish between acute and chronic forms of erythema nodosum.

Symptoms

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

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

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

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

Depending on the nature of the course, the severity of the symptoms of erythema nodosum and the duration of its appearance, three types are distinguished. The symptoms of each type of pathology are slightly different.

Erythema nodosum has two forms - chronic and acute. The acute stage is characterized by a sudden sharp deterioration in health, an increase in body temperature to 38 degrees, loss of appetite, and chills. The acute form lasts approximately 30 days. Patients complain of pain in blood vessels and joints.

Among other diseases, erythema nodosum is distinguished by its most characteristic symptom - the appearance of painful nodes on the skin of the legs, knees, and sometimes in the facial area. On palpation, some swelling may be felt.

Such nodes change color - at first they become pink, red, bluish-violet. Then they acquire a brownish-brown color, after which they become light yellow and disappear.

There are many cases where characteristic red rashes were found after suffering from a sore throat, taking certain antibiotics, sulfa drugs, contraceptives and iodine.

Doctors do not deny the influence of the hereditary factor. Chronic infections (tonsillitis, pyelonephritis, sinusitis) and diseases of allergic origin can also cause the development of this disease.

Erythema often affects people with diseased blood vessels.

It can also result from:

tuberculosis;
sarcoidosis;
leukemia;
lymphogranulomatosis;
streptococcal infection (scarlet fever, streptoderma);
venous diseases;
fungal infection;
rheumatoid arthritis;
lupus erythematosus;
nonspecific ulcerative colitis;
less often - cancer or leprosy.

Factors contributing to the development of the disease in pregnant women are disturbances in the functioning of the endocrine organs, blood stagnation in the lower extremities, prolonged exposure to cold, seasonal weather changes, and hypertension.

Causes

The disease can be either idiopathic, i.e. independent, or a consequence of previously suffered diseases. Causes of the disease:

yersiniosis;
streptococcal infection;
sarcoidosis;
histoplasmosis;
introduction of bacterial antigens;
tuberculosis.

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

Acute and chronic forms develop for the following reasons:

The main impetus for the development of acute erythema nodosum is respiratory, as well as acute viral disease. Many cases are marked by the appearance of spots with a rise in body temperature and poor health. The disease is characterized by unpleasant sensations in the joints of the legs.

Erythema nodosum can be physiological and appear after various effects on the skin. The cause of erythema nodosum is massage, rubbing the skin with warming creams, as well as alcohol tinctures.

Sometimes the disease erythema nodosum appears after taking medications, but there are cases of appearance after nervous, intense stress. The disease loves workaholics, who often experience nervous strain.

However, often the causes of acute erythema nodosum are tuberculosis bacillus, coccal infection and yeast-like pathogens.

The main reasons for the progression of erythema nodosum in humans have not yet been precisely established. Scientists suggest that the hereditary factor plays an important role in the development of this pathology.

They also note that in some clinical situations, erythema nodosum is a nonspecific immunoinflammatory syndrome. Infectious and non-infectious causes can provoke the manifestation of pathology.

Non-infectious causes:

The term “erythema nodosum” was introduced in 1807 by Robert Willan, a British dermatologist. Research by scientists has proven that erythema nodosum is one of the variants of allergic vasculitis.

In most patients, local damage to the vessels of the lower extremities accompanies the course of various diseases. Sometimes erythema manifests itself as an independent pathology.

The main cause of the disease is various types of infections. The most common pathogen is streptococcus.

Erythema nodosum accompanies:

give birth;
sore throat;
otitis;
acute pharyngitis;
rheumatoid arthritis;
streptoderma;
cystitis;
yersiniosis;
inguinal lymphogranulomatosis and others.

Doctors still cannot explain exactly why primary erythema nodosum develops in humans. And the majority is inclined to believe that heredity - genetic predisposition - is to blame for everything.

People with the following ailments are prone to a chronic course of the disease:

vascular diseases (varicose veins, thrombophlebitis and atherosclerosis of the lower extremities);
allergic diseases (bronchial asthma, dermatitis, hay fever);
chronic infectious diseases (tonsillitis, sinusitis and pyelonephritis).

Secondary erythema has various causes; its development can be triggered by the following factors:

Classification of the disease and its symptoms

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

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

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

Symptoms of the disease

The disease is caused by the appearance of a hyperergic reaction to medicinal and bacterial allergens. And the main places where the rashes are concentrated are the front and side surfaces of the lower leg.

The condition of a patient with erythema nodosum is aggravated by chronic diseases. These are dental diseases, tonsillitis, tuberculosis, otitis media, and other viral infections.

Erythema nodosum falls under the category of independent disease when it is difficult to find out the cause.

Characteristic signs of vascular pathology:

How does a sick person feel? The main symptoms of this disease:

bad feeling;
weakness;
chills;
fever.

Nodular seals form on the second or third day after the patient begins to feel unwell. As a rule, the area of distribution of nodes is the anterior and lateral surface of the lower leg.

But there are cases when erythema nodosum is observed not only in the lower regions of the legs, but also on the thighs, arms, and forearms. Almost always, dense nodules are located symmetrically.

Diagnostics

Basic diagnostic methods for suspected erythema nodosum:

blood analysis;
bacteriological culture;
nodule biopsy;
CT scan;
rheovasography;
Doppler ultrasound examination of the venous vessels of the lower extremities.

The most informative is histological examination. With its help, it can be established that the inflammatory reaction is localized in the subcutaneous tissue and in the lower layers of the dermis. Necrosis and tissue abscess are not diagnosed.

Differential diagnosis is very important, as it allows you to more accurately determine the presence of erythema. It makes it possible to identify the causes of erythema and outline possible treatment methods. The diagnosis can be made only after conducting a set of necessary studies.

There are the following methods for diagnosing the disease:

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

Such a thorough diagnosis allows you to determine treatment in adults and children. You should not refuse all necessary examinations, since recovery depends on them.

Diagnostics includes laboratory and instrumental examination methods:

Choosing the right type of therapy is difficult. Nodular rashes of various sizes are symptoms of many pathological processes in the body.

Diagnosis is quite specific. Tests are required to exclude or confirm the presence of underlying diseases. The list of “suspects” is wide – from tuberculosis to otitis media.

Mandatory studies:

bacterial culture from the nasopharynx;
blood test for rheumatoid factor;
tuberculin diagnostics;
pharyngoscopy;
computed tomography of the lungs;
a detailed blood test to determine the level of SES;
stool culture;
rhinoscopy;
X-ray of the lungs;
Doppler ultrasound of the veins of the lower extremities.

The unknown origin of the formations requires a biopsy of the nodes. Histology reveals the degree of development of the inflammatory process.

The effectiveness of therapy depends on the results of treatment of the cause of the inflammatory process and the elimination of associated pathologies. Good results are achieved by combining:

medicines;
physiotherapy methods;
traditional medicine recipes.

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If erythema nodosum appears, who treats this disease? First of all, you need to contact a dermatologist, because this is a skin pathology.

Although the signs of erythema nodosum are obvious, the doctor will always prescribe additional tests, such as:

Blood analysis.
Bacteriological culture.
Biopsy of the contents of the nodules.
Examination under a microscope.

If necessary, the patient may be referred for Doppler ultrasound of the vessels of the legs. To find out the cause of the disease, consultations with other specialists will be needed.

Differential diagnosis is a diagnosis that, based on facts or symptoms, excludes diseases and, in the end, leads to the formulation of a single correct diagnosis.

Erythema nodosum can be confused with the following diseases:

Thrombophlebitis. In this case, the disease also forms compactions that are painful when pressed, but they are localized along the veins and have a tortuous appearance. The patient complains of muscle pain, legs swell. If the blood clot becomes infected, then intoxication of the body occurs - the patient suffers from weakness and high fever.
Erysipelas or erysipelas is an acute infectious disease caused by streptococcus. There is a sharp rise in temperature to 38–39 °C and weakness. Then burning and pain in the affected areas, which swell over time. The area of redness has jagged edges, rises above healthy skin, and feels hot and tight to the touch. Sometimes bubbles form that are filled with liquid. Unlike erythema nodosum, erysipelas is characterized by inflammation of the lymphatic vessels and nodes.
Erythema of Bazin or indurative tuberculosis. Rashes form on the back of the lower leg. Nodes form slowly. They do not become inflamed and do not rise above healthy areas. The skin over them has a blue-red color, which does not tend to change. However, the nodes can turn into ulcers and leave behind scars.
Christian-Weber disease. Characterized by inflammatory processes in subcutaneous fatty tissue. Small subcutaneous lumps form on the forearms, thighs and torso, which are moderately painful when pressed.

Erythema nodosum always requires diagnosis to be confirmed. The first thing you need to do is a blood test, which determines the increased number of leukocytes and ESR.

If a bacteriological culture is carried out from the nasopharynx, a streptococcal infection is often isolated. If articular syndrome is present, then this is a reason to go to a rheumatologist.

If the diagnosis cannot be made based on clinical signs, then a biopsy of one of the nodules on the legs has to be performed. In order to understand what caused the disease, consultation with many specialists and studies such as:

Rhinoscopy.
Pharyngoscopy.
X-ray of the lungs.
Rheovasography.
Ultrasound scanning of the leg veins.

Once the cause of the disease has been identified, treatment can begin.

Treatment of the disease

Therapy for erythema involves treating the underlying cause of the disease. Treatment of erythema nodosum is based on the use of combination therapy.

Patients are reduced the load on the lower extremities and recommended bed rest. Salicylates are prescribed (Askofen, Aspirin), and it is mandatory to take antihistamines - Suprastin, Zyrtec, Diazolin, Telfast, Tavegil or Claritin.

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

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

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

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

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

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

Treatment using traditional methods

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

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

After visiting a doctor, the patient will be prescribed an x-ray of the lungs to rule out tuberculosis and sarcoidosis, and will be recommended to do a smear for streptococcus and a test for Yersinia. To exclude infections, various blood tests will be prescribed.

Treatment of erythema nodosum should only be carried out by a highly qualified specialist. If the doctor was able to determine which disease provoked the development of the pathology, then first of all, it is necessary to begin treating it.

If erythema nodosum has developed against the background of an infectious disease, then antiviral, antibacterial and antifungal drugs are prescribed.

For the primary form of pathology, the following drugs are prescribed:

antihistamines;
non-steroidal anti-inflammatory drugs;
aminoquinoline drugs;
corticosteroids.

For local treatment, it is recommended to use anti-inflammatory ointments (including hormonal ones) and make compresses. Physiotherapy also has a good effect in treating the disease. Laser therapy, phonophoresis, magnetic therapy, and ultraviolet radiation are prescribed.

As an additional therapy, you can use folk remedies, but only after agreeing with your doctor. Uncontrolled use may not only not help, but also aggravate the course of the disease.

Folk remedies for the treatment of erythema nodosum:

Long before the advent of medicine, nature made sure that a person could speed up recovery with the help of medicinal plants. Modern medicine does not refute the fact that treating erythema with folk remedies can give positive results.

However, before using them, it would be much wiser to first consult with your doctor.

Erythema nodosum treatment involves complex treatment. Therapy is carried out in the following areas:

Drug treatment.
Physiotherapeutic procedures.
Traditional medicine recipes.

Need to know. When selecting treatment tactics for a patient, the doctor must take into account that it should not only relieve the manifestations of the disease, but also eliminate provoking factors.

How to fight a disease with medications

Complex drug treatment involves the use of the following means:

If the pathology develops as a result of an existing inflammatory disease, then the use of antibacterial drugs, for example, Penicillin, Tetracycline, is indicated.

Advice. The pathology will recede faster if you also take Prednisolone along with antibiotics.

Ointments or creams that have anti-inflammatory properties and accelerate tissue repair are prescribed externally. If erythema nodosum appears in children, then you can use Vishnevsky ointment, “Acemin”.

Therapy with non-steroidal anti-inflammatory drugs - Ibuprofen is suitable.
To eliminate the allergic factor, taking antihistamines (Tavegil, Suprastin) is indicated.
If the disease is chronic, then treatment must be supplemented with aminoquinoline drugs, for example, such as Delagil or Plaquenil.
To restore blood vessels, taking angioprotectors (Trental, Escusan) is indicated.

The painful manifestations of the disease can be removed using laser irradiation and hemosorption.

Treatment with physiotherapeutic methods

Physiotherapy is an excellent addition to drug therapy. The following procedures are prescribed to patients:

Magnetotherapy.
Phonophoresis with Hydrocortisone.

Laser treatment.
Diathermy.
Compress with ichthyol solution.

Treatment usually ends with the prescription of immunomodulatory agents and vitamin preparations.

Important. If erythema is detected in a woman during pregnancy, then all treatment should be strictly under the supervision of a doctor. You cannot prescribe medications for yourself.

Traditional medicine against erythema

When such a pathology appears, many people wonder how to treat erythema nodosum at home. We can recommend using the following recipes from traditional healers:

Treatment is prescribed and carried out by a specialist after identifying the exact cause of the disease:

To relieve general symptoms, antihistamines, as well as a number of pharmacological agents of a number of salicylates, can be prescribed. Depending on the tests and reasons, antibiotics are prescribed.
Skin lumps are treated with anti-inflammatory and hormonal ointments, which are prescribed by the doctor for each case individually.
Physiotherapeutic methods include phonophoresis, warming compresses, and UHF.

Girls are more susceptible to this disease than boys. Erythema nodosum is most often diagnosed in children over 6 years of age.

At the same time, the child becomes very whiny and capricious, complains of pain in the abdomen and joints, red spots of different sizes and very painful nodes form on his legs.

The limbs swell, the pain intensifies with movement.

Anti-inflammatory drugs Aspirin, Brufen, Indomethacin are used to treat children. Warm compresses with heparin or ichthyol ointment are placed on the area of the rash.

As for erythema in expectant mothers, it is absolutely safe for the fetus. But the woman’s health is at risk because the disease can cause complications in the heart. For the treatment of erythema nodosum during pregnancy, the following is prescribed:

lubricating the affected areas with Indovazin ointment, Deep-relief ointment;
minimum dosage of Paracetamol;
to reduce inflammation - Aspirin (in the smallest doses);
Curantil tablets;
in severe cases - Diclofenac injections;
Antibiotics may also be prescribed (usually macrolides or cephalosporins), but only in the 2nd trimester.

Important! If signs of erythema appear in a child or expectant mother, then making a diagnosis on your own, much less engaging in treatment (even with herbs), is strictly prohibited! This can lead to unpredictable consequences.

The patient should definitely reduce the load on her legs, but, of course, she should not lie in bed all day.

Complications and consequences

The lack of proper therapy will provoke the chronic stage of the disease. You shouldn’t think that in a month or a month and a half “everything will go away on its own.” A full examination and treatment of manifestations of erythema is mandatory.

Do not forget that formations on the skin are a sign of internal problems. Untreated underlying diseases eventually develop into a more dangerous form with serious consequences.

Preventive measures

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

This pathology does not pose a health hazard, because the nodes tend to resolve. But still, it must be treated in order to prevent the development of a chronic form.

People prone to the formation of erythema nodosum need to be attentive to their health and promptly contact specialists when the first symptoms of trouble appear.

Basic Rules:

monitor the condition of the vascular system;
take action at the first signs of varicose veins;
avoid contact with allergens;
undergo regular medical examinations;
treat chronic diseases.

Erythema nodosum on the legs is a serious disease. Use the entire arsenal of remedies suggested by your doctor. With an integrated approach to treatment, the prognosis is favorable.

Skin rashes can be of different sizes and structures. Some of them pose no danger to the human body, while others can warn of serious disorders in the human body. The most common and easily recognized skin manifestation is erythema nodosum, which is located on the lower extremities.

Erythema nodosum is an inflammatory process that affects the skin and adipose tissue. As a result, red nodules form on the surface of the skin. The diameter of the nodules can be as large as cherries, and subsequently grow to the diameter of an orange (see photo).

Erythema may indicate the development of various abnormalities in the body. Usually the exact cause of the disease cannot be determined, so in most cases this pathology is considered as an independent disease.

Causes of the disease

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, the formation of atherosclerotic plaques in the 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;
the presence of 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.

Locations of nodules

In almost all patients, the nodules are located on the anterior surface of the leg. Usually these nodes are located symmetrically, but cases of a single arrangement are known. The formation is best seen where there is subcutaneous fat. Namely:

buttocks;
hips;
forearms;
face;
sometimes even on eyelids.

Symptoms of erythema nodosum

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 pain not only during palpation, but also when walking, lifting weights and even light physical activity.

Forms of erythema nodosum

There is an acute and chronic form of the disease. The chronic course of the disease is very rare; it is usually characterized by the formation of a small number of small dense formations of a pink-bluish color. There are no deformation changes in the joints.

The acute phase develops over the course of a month. Victims experience the following symptoms:

in most patients, body temperature rises to 39°;
the patient’s general condition worsens, muscle and joint pain develops;
the skin begins to swell, the articular surfaces become inflamed, intra-articular effusion forms, and the area turns red;
at the maximum peak of the acute phase, joint pain increases, the patient experiences discomfort in the morning;
after three weeks, the nodules resolve, and the skin begins to peel at the site of their formation;
the joints gradually cease to be painful.

Modern dermatologists identify several more forms of erythema:

Infectious form - the trigger for the development of this type is the presence of an infectious process in the human body.
The toxic form mainly affects newborns. It does not pose any particular danger; the formed nodules disappear without any treatment after just one week.
With the development of Lyme disease, a migratory form occurs, which is triggered by a tick bite.
Recurrent forms of pathology include ring form. It begins to appear when the body is exposed to allergic agents, toxic substances, and infectious pathologies.
Multimorphic exudative erythema. Develops during colds. Nodules form in the area of the lower legs, feet, palms, on the oral mucosa, palms and genitals.

Features of the development of erythema nodosum in young children

This pathology most often occurs in little girls who have reached the age of six years. Nodules begin to form when the skin is exposed to cold temperatures, namely in the autumn-winter period. The main symptoms of the disease begin to appear on the sixth day.

The sick child is very capricious and complains of a general malaise. He feels pain in the joints and abdominal cavity. The nodules are very painful and have an elevated temperature.

Usually this disease is associated with joint pathology. In this case, the joints begin to swell, redness and pain develop during movement. The inflammatory process in the joints subsides after two to three days, but the pain persists for some time.

Erythema nodosum on the legs should be treated with non-steroidal anti-inflammatory drugs. Children are usually prescribed medications such as Acetylsalicylic acid, Indomethacin, Nurofen. Compresses with a warming effect are applied to the site of formation of the nodule. For compresses, use ichthyol solution or heparin ointment. Treatment procedures should be carried out under the supervision of a doctor.

General principles of treatment of the disease

Before starting treatment, the patient must undergo an X-ray examination of the lungs so that the attending physician can exclude 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.

It is necessary to mentally tune in to a favorable outcome of treatment, that is, discard all negative thoughts. Since they are the ones who prevent most patients from being cured of this pathology. It is necessary to free the body from harmful substances and toxins, special attention should be paid to such organs as the liver and intestines. It is recommended to use therapeutic fasting or specially selected diets (vegetable, berry, buckwheat, fruit, kefir). Comprehensive treatment of erythema nodosum includes the following points:

drugs to lower body temperature;
non-steroidal anti-inflammatory drugs;
antibacterial drugs;
ascorbic acid and rutin;
hormonal drugs;
autohemotherapy;
plasmapheresis;
ointments containing Heparin;
wraps and compresses with a warming effect.

If you find one or more hot red spots on your lower extremities, under which painful nodes can be felt, then this may be erythema nodosum. It appears on the legs. Which doctor will treat her? What medications and folk remedies can be used for this problem?

What kind of disease is this, how dangerous is it and can you get infected with it?

“Erythema nodosum” is a fairly common diagnosis. What it is? It is an inflammatory disease that affects small vessels located in the dermis and subcutaneous fat. Its main symptom is the formation of red spots and dense painful nodes under the skin.

Anyone can get erythema nodosum, but young women (including pregnant women), older women and children are at increased risk. At the same time, it is especially difficult for young patients to tolerate it.

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It is impossible to say definitively whether this is a dangerous disease. If it occurs as an independent disease, it does not pose a threat to humans. The formations disappear without leaving a trace, are highly treatable and rarely recur. If erythema nodosum on the legs is the result of any serious illness, then the prognosis depends on whether it can be cured. It is impossible to become infected with erythema, but it is quite possible to catch the infection that provoked it.

Why do “nodules” appear?

There are many cases where characteristic red rashes were found after suffering from a sore throat, taking certain antibiotics, sulfa drugs, contraceptives and iodine. Doctors do not deny the influence of the hereditary factor. Chronic infections (tonsillitis, pyelonephritis, sinusitis) and diseases of allergic origin can also cause the development of this disease. Erythema often affects people with diseased blood vessels.

It can also result from:

tuberculosis;
sarcoidosis;
leukemia;
lymphogranulomatosis;
streptococcal infection (scarlet fever, streptoderma);
venous diseases;
fungal infection;
rheumatoid arthritis;
lupus erythematosus;
nonspecific ulcerative colitis;
less often - cancer or leprosy.

Factors contributing to the development of the disease in pregnant women are disturbances in the functioning of the endocrine organs, blood stagnation in the lower extremities, prolonged exposure to cold, seasonal weather changes, and hypertension.

Girls are more susceptible to this disease than boys. Erythema nodosum is most often diagnosed in children over 6 years of age. At the same time, the child becomes very whiny and capricious, complains of pain in the abdomen and joints, red spots of different sizes and very painful nodes form on his legs. The limbs swell, the pain intensifies with movement.

Anti-inflammatory drugs Aspirin, Brufen, Indomethacin are used to treat children. Warm compresses with heparin or ichthyol ointment are placed on the area of the rash.

lubricating the affected areas with Indovazin ointment, Deep-relief ointment;
minimum dosage of Paracetamol;
to reduce inflammation - Aspirin (in the smallest doses);
Curantil tablets;
in severe cases - Diclofenac injections;
Antibiotics may also be prescribed (usually macrolides or cephalosporins), but only in the 2nd trimester.

Important! If signs of erythema appear in a child or expectant mother, then making a diagnosis on your own, much less engaging in treatment (even with herbs), is strictly prohibited! This can lead to unpredictable consequences.

The patient should definitely reduce the load on her legs, but, of course, she should not lie in bed all day.

How can traditional medicine help?

You should seek help from a dermatologist or rheumatologist, but you may need to consult an infectious disease specialist, pulmonologist, ENT specialist, vascular surgeon, or phlebologist. To cure erythema nodosum means to find and eliminate the cause that caused it. For this purpose, the following drugs and methods of therapy are used:

if there is a focus of infection, then antibiotics are prescribed - Penicillin, Rifampicin, Tetracycline, Streptomycin. They are prescribed for 1-2 weeks. To enhance the effect, small doses of corticosteroids are used in parallel with them - Prednisolone 15-20 mg once a day after breakfast;
drugs that reduce inflammation - acetylsalicylic acid (0.5-1 g per day), Ibuprofen (dosage individual), Indomethacin (25 mg 2 to 3 times per day);
potassium iodide - 300-900 mg for 2-4 weeks;
vitamins C and P;
plasmapheresis;
in exceptional cases - hormones;
Among the methods of physiotherapy, magnetic and laser therapy, ultraviolet irradiation, and phonophoresis with hydrocortisone have proven themselves to be the best.

The green pharmacy offers its own recipes for eliminating this problem. But they can only be used for primary erythema nodosum:

for oral administration - decoctions of lemon balm, mint, yarrow, red rowan berries, rose hips, hawthorn, elderberry leaves, lingonberries, birch. They should be prepared according to one recipe: 1 tbsp. l. vegetable raw materials, pour 1/2 liter of boiling water, leave for 1-2 hours, drink 1/3 tbsp. before meals;
for topical use - an ointment made from dried and crushed arnica roots (100 g) and the same amount of pork fat. Combine these ingredients and simmer in the oven for 3 hours. Cool. Apply the ointment to the affected area at night under a gauze bandage;
compress of freshly squeezed nettle juice.

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 be allergic in 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

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 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, the nodes affect the oral mucosa, limbs, hands or palms;
speaks of a 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

The classic external indicator of the disease is fairly 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 the 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 the 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 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 the concomitant inflammation of chronic disorders, you may need research from a pulmonologist, vascular surgeon, infectious disease specialist, and you 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. A complete examination at an early stage of erythema nodosum and identifying its cause will help the necessary 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 progress to the chronic stage of the disease. Therapeutic prognosis is completely positive in the absence of pathological forms.

Children and pregnant women

The clinical picture in a child is 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. Usually they settle on treatment without medications, including bed rest and elastic bandages to fix the 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.