Erythema nodosum of the lower extremities. Causes, symptoms, pictures, treatment in children, pregnant women, adults. Ointments, pills, folk remedies

Nodular erythema - painful disorder characterized by inflammation of the subcutaneous fat, occurring in the acute or chronic form. Erythema develops most often in young women as toxic-allergic reaction. When the disease affects the lower extremities vessels - arteries, veins, capillaries. The causes of the syndrome are poorly understood.

The causes of lower limb pathology

Erythema in women occurs in 3-6 times more often than men. It strikes at any age, but usually occurs between the second and fourth decades of life. During this period, the highest prevalence of sarcoidosis, streptococcal and other infections. In pubertal age groups, the prevalence of the disease is the same for boys and girls.

Inflammation occurs in the subcutaneous fat layer, causing the formation of red rounded lumps, nodules, tender to the touch. Location of their distribution - both legs. Erythema nodosum of the lower extremities, the causes of which are still unknown, caused by increased reaction of the immune system to a particular stimulus.

The most common triggers are:

• pregnancy;
  
• sarcoidosis;
• rheumatological disease;
• infection;
• inflammatory bowel disease;
• autoimmune disorders;
• malignant neoplasms;
• medications.

According to the classification, erythema subdivided into idiopathic which has arisen without apparent reason, and domestic premises and the secondary, which can be a sign of serious disease.

Contributing factors are congestion of the lower extremities, prolonged hypothermia, vitamin deficiencies of vitamins C and E, endocrine disorders. The disease develops mostly in autumn and spring seasons.

Non-infectious causes

Erythema nodosum of the lower extremities, the causes of which are not related to infections, it may be under the influence of:

• Drugs: antibiotics, penicillin, sulfonamides.
• Oral contraceptives.
• Inflammatory bowel disease.
• Pregnancy.
• Certain types of cancer, including lymphoma, leukemia.
• Other diseases: celiac disease, systemic lupus erythematosus, ulcerative colitis, reactive arthritis, nephropathy.

infectious causes

Among the causes of erythema, streptococcal infections are paramount. Defined and many other reasons, among them.

bacterial:

• tuberculosis;

  

• syphilis;
• chlamydia;
• brucellosis;
• yersiniosis.

viral:

• Infectious mononucleosis;
• hepatitis C, B;
• HIV;
• herpes simplex virus.

fungal:

• histoplasmosis;
• blastomycosis.

parasitic:

• amebiasis;
• giardiasis.

Forms and symptoms of the disease

The disease is distinguished by the presence of etiological factors:

• primary stage when the underlying condition is not yet ascertained;
• secondary stage at which the defined disease provoked erythema;

According to the severity of erythema disease occurs in acute, subacute, chronic.

Nodules arising on the skin surface, are their stages of development:

• The first stage, maturation. Is characterized by moderately painful condition, pink color, do not have clear boundaries, develops within 4-7 days.
  
• Mature or unfolded stage. It is characterized by nodes bright red, painful, with clear boundaries, swelling of the surrounding tissue. All the symptoms persist for 10-12 days after the disease.
• The resolution stage. The color scheme is developed to blue-yellow color, tenderness goes, compacted loses boundaries, stage duration up to 14 days.

By course of the disease, severity, limitation inflammation distinguish erythema nodosum 3 types: acute form, migrating, chronic.

Acute erythema nodosum

Erythema nodosum of the lower extremities, the causes of which are often associated with chronic infections, intoxication, may occur as an inflammatory process in the acute form. In this case, the disease is characterized by the rapid development of painful bright red anti-inflammatory therapies nodes.

Large formation, the size of a walnut, act on tibiae surface in a symmetrical arrangement, at least - on the thighs and arms. Nodes are raised above the surface, they do not have clear boundaries, but they do not merge with each other, do not form an ulcer. In the future, the nodes change color, acquiring first blue, then pass into the greenish, yellowish tint.

The color change like a "bloom bruise." Associated symptoms: fever, sometimes up to 39˚S, headache, weakness, joint pain.

Nodes preceded by the appearance of the disease:

• streptococcal tonsillitis;
• pharyngitis;
  
• viral infections.

After treatment of the underlying disease disappear after 4-6 weeks and nodules. Repeat the process is not observed, scarring in the tissue remains.

migrating form

This shape is a group of several clinical variations, assumes the character of an acute and subacute process, there is no asymmetric performance plaques on the shins. Initially, there is a single node on a tight calf. Then there is a change of the skin color of the node, it becomes a bluish-red shade.

Due to the inflammatory process is formed annular piece with pale sunken center and a wide peripheral area of ​​saturated color. During this period, fine nodules can appear both around the main body, and the other tibia. Additional symptoms: fever, joint pain, weakness, disease lasts from several weeks to several months.

The chronic form

Chronic course of the disease occurs in women of middle and old age, is characterized by persistent recurrent character. It appears on a background of protracted frequent infections, inflammation or tumors in the pelvic organs, vascular inflammatory disorders.

Distributed nodes, the size of a walnut, on anterolateral calf have moderate pain, puffiness.

In the initial period of the skin color does not change, the nodes do not rise, and to identify them only by means of palpation. The disease is due to seasonal periods of exacerbation begin in autumn and spring. All nodes are replaced each other, one resolve, new arise.

Especially leakage and the risk of disease

Erythema preceded by a period during which the person feels extremely weak and gets tired quickly, there is fever, swelling in the joints, pain, stiffness. Symptoms often resemble signs of incipient flu. Pain in the legs and joints continues for some time after the eruption.

Erythema manifested by sudden eruptions. If during the acute, it is accompanied by fever, abdominal pain, vomiting, diarrhea. Nodules appear symmetrically on the legs, in the anterolateral part. In rare cases, spread over the surface of the hands, neck and shoulder.

Externally bundles are soft, warm thickening, from 1 to 5 cm in diameter. Initially, they have a bright red color, and then change it to blue-yellow. Border nodes fuzzy, because the surrounding tissue is swelling. On palpation of nodes can be painful. Rashes on the skin remain for a few weeks or months, then heal without atrophy nodules and scarring.

children

Erythema nodosum in childhood is acute. It is characterized by painful lesions that appear on the lower extremities, in the lower leg, which can merge with each other.

The cause of:

• response to tuberculosis;
• streptococcal infection of the upper respiratory tract.
• reaction to antibiotics, sulfonamides.

The disease is accompanied by symptoms:

• pain in the muscles and joints;
• feeling of weakness;
• heat;

adults

Currently, the leading cause of erythema in adults is sarcoidosis. occurrence frequency is up to 65% in different regions. Often, erythema nodosum combined with joint disease.

Other symptoms accompanying erythema develops on the background of sarcoidosis:

• strong edema of the lower extremities;
• arthralgia ankles
• the large size of nodules, their merger;
• cough, chest pain, shortness of breath.

Frequent causes for the syndrome is an inflammatory bowel disease, and use of medicines. Tuberculosis is currently not a common cause of erythema nodosum.

during pregnancy

When gestation, when there is a reorganization of endocrine and immune cascade, female, hatching baby may develop erythema nodosum. This occurs in 8% of pregnant women. During this period, it is crucial timely screened for infectious markers. The presence of herpes simplex viruses, mycoplasma, chlamydia contributes to the development of erythema syndrome.

Diagnostics

The diagnosis is determined by the clinical manifestations, but to confirm it appointed and other studies:

• biopsy;
• skin sample;
• chest X-ray;
• general analysis of blood and urine;
• throat swab;
• Ultrasound of the internal organs.

Differential diagnosis, to cut off the disease:

• extrapulmonary tuberculosis;
• panniculitis;
• lipogranuloma;
• nodular vasculitis;
• migratory thrombophlebitis;
• Skin calcification;
• insect bites;
• acute urticaria.

Treatment of erythema nodosum

Nodular erythema lower limbs, the causes of which are essential for the treatment involves the use of drug therapy, painted on a particular circuit.

In order to achieve a positive result doctors put 2 goals: achieving remission and improving the quality of life of the patient. In most cases, bed rest is appointed, the lower extremities should be in a good state, appointed a hot compress.

Treatment of secondary erythema is aimed at eliminating the underlying disease. It serves to reduce inflammation potassium iodide, 300-500 mg orally 3 times per day. Systemic corticosteroids are appointed in the last turn, because they can worsen the symptoms of the underlying disease.

Pharmacy drugs against erythema nodosum

Nodular erythema, her treatment includes anti-inflammatory drugs, corticosteroids are administered orally or topically. Sometimes doctors prescribe alkaloid colchicine to reduce inflammation in the skin of the lower extremities. Therapy should be tailored to a specific person, take into account all the causes of the disease.

First appointed non-steroidal anti-inflammatory drugs. Scheme therapy depends on the stage of the disease, the diagnosis of the underlying disease.

drugs group	Name
NSAIDs	indomethacin Voltaren Meditol nicotinate ksantinola
antibiotics	erythromycin Tseporin Penicillin doxycycline amoxiclav
salicylates	Aspirin askofen
Angioprotectors	Aescusan trental komplamin
anticoagulants	heparin
vitamins	askorutin Sinkumar Ruthin C, B, PP
Glucocorticosteroids (in case of failure of previous preparations)	prednisolone

When treating pregnant 1 trimester assigned local therapy consisting of appliques 33% solution of dimethyl sulfoxide, nimesulide. In the 2nd trimester prescribers NSAIDs, local therapy in the form of lotions. Appointment of drugs, the dose should be strictly coordinated with the doctor.

Ointments with erythema nodosum

For the topical treatment applied absorbable, anti-inflammatory drugs and medications that have a mikrotsirkuliruyuschee effects on blood vessels.

Appointed by packs:

• dibunola liniment, 5%;
• ihtiola solution, 10%;

For applications of the prescribed drugs: 33% solution Dimexidum, Nimesulide. Applications should be a day for 2 times, a course of treatment - at least 25 procedures.

To enhance the therapeutic effect pre-lubricate the affected surface ointments:

• Prednisolone.
• Hydrocortisone.
• Flutsinar.

Locally applied dry heat, UHF, phonophoresis with 5% liniment BHT, phonophoresis with ligase, heparin. Recently used laser effect on the lesions.

Treatment of erythema nodosum folk remedies

As adjuvant treatment in idiopathic form of erythema may be used solutions, extracts of herbs having anti-inflammatory effect.

Horse chestnut and sweet clover:

• Stir for 1 hr. l. and chestnut leaf clover, pour hot water. The mixture is placed in a water bath to keep 15-20 minutes. After settling strain, take 1 tbsp. l. 4 times a day.

Aloe vera, honey, lemon:

• Take 1 h. l. the pulp of aloe, honey and lemon juice. In the mixture, add a little milled walnuts. Composition take 1 hour. l. half an hour before a meal.

Chamomile extract:

• The plant has anti-inflammatory and antibacterial properties. For infusion take 1 hour. l. herbs, pour boiling water, boil for 5-8 min. Drink 2 times a day.

Packs of green tea, tea tree oil, apple cider vinegar:

• All of these products are a good antimicrobial agent to help heal the nodules with erythema.
• Saturated brew green tea, moisten a cotton swab in it and make application to the affected places.
• Dilute 10 essential tea tree oil drops in a tablespoon of vegetable or sea buckthorn oil. The composition of the rub into the skin, leaving for 15 minutes. Then wash with water.
• Moisten a cotton swab in acid and make application to the affected areas.

Oat groats:

• Effective against irritation, inflammation.
• Add a cup of chopped oatmeal in a bath filled.
  
• Take a bath for 30 min.
• For applications to mix an equal amount of milled oatmeal with natural yoghurt. The resulting slurry was applied to the skin, to hold not more than 15 min., Then rinse with cool water.

A mixture of orange with yogurt:

• Mix natural orange juice with natural yoghurt.
• Use a mix of applications, leaving on the skin for 30 minutes. Then wash.

In drawing up the diet should pay attention to the products:

• Serving as possible, organic products in which fewer toxins, chemicals.
• Eat more yellow, orange vegetables and fruits. They cause the body's resistance to the rash.
• Eat clean low-fat protein. This will help protect against infections.
• Often added to soups, salads, flax seeds, flax oil to use, better cold-pressed.
• Supplementing the diet with vitamin C in pure form or in the products, it should be at least 2 thousand. mg per day.
• Use quercetin, an anti-inflammatory flavonoid contained in natural red wine, green tea and onions.

Erythema is a syndrome that occurs in the everyday practice of doctors of many specialties. Treatment of nodular lesions in the lower limbs is not only directed at addressing the underlying disease, but also to reduce the recurrence of the inflammatory process. Although its causes are vague, but the final effect is always positive.

Registration of the article: Lozinski Oleg

Video of erythema nodosum of the lower limbs

Erythema nodosum. Treatment of erythema nodosum: