And whether you know...
Knotty (nodal) erythema
The knotty erythema is a disease at which defeat of skin and hypodermic vessels of inflammatory character is observed. This disease has the allergic nature. In the course of its development in the patient dense semi-spherical painful nodes appear. They can have the different size and most often appear symmetrically on the lower extremities.
The term "nodal erythema" was introduced by the dermatologist from Great Britain Robert Willan in 1807 for the first time. Later researches gave the chance to draw a conclusion that the nodal erythema is one of options of an allergic vasculitis. If to compare disease symptoms to system vasculites, then at a nodal erythema local defeat of vessels which mainly appears standing is noted.
The illness can be shown at patients at any age, however most often the disease affects people in an age group from 20 to 30 years. If till the puberty period the nodal erythema is widespread equally among both floors, then after this period the knotty erythema meets at women by 3-6 times more often. The quantity of cases increases in winter and spring time.
Reasons of a knotty erythema
The nodal erythema develops in a human body in connection with manifestation of infectious processes. First of all, it is about streptococcal infections. Therefore, the illness develops at quinsy, scarlet fever, pharyngitis, otitis and other diseases. Also symptoms of a nodal erythema are shown at TB patients. Less often the illness develops at an iyersinioza, a trichophytosis, a koktsidiomikoza, an inguinal lymphogranulomatosis. Besides, the medicamentous sensitization owing to reception of streptocides, salicylates, iodides, bromides, antibiotics, and also as a result of vaccination can become a cause of illness also.
Often acute knotty erythema at children and adults is shown at a sarcoidosis. The noninfectious reasons for which the disease develops it is Bekhchet's illness, inflammatory illnesses of intestines, ulcer colitis, oncological diseases. But in these cases symptoms of a disease are shown less often. The nodal erythema can arise also at pregnancy, in the presence in an organism of the centers of persistent infection. Sometimes the nodal erythema is diagnosed for several boats of a family, that is it is possible to speak about hereditary tendency to a nodal erythema. People at whom the disturbances connected with vessels, tendency to allergic diseases are observed are inclined to the chronic course of a disease.
It is very important that diagnosis of a disease was carried out timely and qualitatively. Defining how to treat a nodal erythema, the doctor has to find out what became its prime cause. But anyway treatment of a knotty erythema is always carried out only under control of the specialist.
The main display of this disease is existence of dense nodes which are located in lower parts of a derma or in hypodermic cellulose. Such nodes can have different diameter: it varies from 5 mm to 5 cm. Over nodes skin red and smooth. Nodes tower over the general integument a little, but a clear boundary is not observed as fabrics swell around. Such nodes grow very quickly, but, having increased to a certain size, they stop growing.
People with a nodal erythema can have a different pain. It can be shown as during a palpation, and from time to time to arise spontaneously. The itch in the struck places is not shown.
Approximately in 3-5 days there is permission of nodes. They are condensed and do not break up. A characteristic symptom – change of coloring of an integument in places over nodes. This process is similar to how gradually there passes bruise. At first skin becomes brownish, and then becomes blue, and gradually turns yellow.
Most often nodes at a knotty erythema appear on a front surface of shins. In most cases defeat is symmetric, but unilateral or single rashes are sometimes observed. In all places of a body where there is a hypodermic fatty tissue, elements of a knotty erythema can appear. They appear on calves, hips, buttocks, persons, and sometimes and on an eyeglobe episclera.
Most often the knotty erythema begins sharply. At the person fever, a fever, weakness, lack of appetite is noted.
At the most part of patients with a nodal erythema arthropathies are observed: the joint pain, morning constraint, morbidity at palpation disturbs. Approximately at a third of patients symptoms of inflammatory process in a joint (arthritis) are observed. Skin in a joint reddens and swells, the intra articulate exudate is observed. In the presence of a joint syndrome at patients with a knotty erythema large joints are surprised symmetrically. Small joints of brushes and feet can swell. The general symptoms and arthropathies will sometimes roll about for several days earlier, than elements on skin.
Depending on disease severity for two-three weeks nodes are completely resolved. On that place where they were located, some time can be noted hyperpegmentation and a peeling of skin. When skin manifestations disappear, the joint syndrome also passes. The acute period of a disease proceeds for about one month.
Chronic disease with periodic recurrence is observed in more exceptional cases. At aggravations a small amount of nodes appears. As a rule, nodes happen single, they dense, cyanotic-pink also can remain for several months. Sometimes manifestations on skin are followed by a chronic arthropathy, but at the same time joints are not deformed.
That treatment of an erythema was the most effective, in the course of diagnosis the type of an erythema surely is defined. Several different types of this disease are allocated. The toxic erythema appears at newborn children and is physiological norm. The child has enanthesis. Other symptoms are not observed. This natural manifestation which disappears independently approximately in a week after emergence.
The infectious erythema arises at the person having acute infectious illnesses of the obscure etiology. It is shown both at adults, and at children.
The Mnogoformny exudative erythema, as a rule, develops at catarrhal diseases. Characteristic symptoms of a disease is the severe headache, a febricula and weakness, a joint pain and a rash throat which generally appear on integuments of brushes and feet, and also on palms, shins, generative organs, mucous a mouth. Pronounced rashes can be distinguished even on a photo. These are the reddish spots having a clear boundary which sometimes becomes bubbles with serous contents which are opened independently then there are bleeding erosion. If an illness not to treat, there can be a lethal outcome.
The migrating erythema is a characteristic symptom of an illness of Lyme which is transferred in process of a sting of a tick. Around that place where the tick stuck, there is a ring-shaped erythema which very quickly increases and at the same time turns pale in the center.
Ring-shaped erythema – a chronic disease. The reasons of its manifestation – organism poisoning, infectious diseases, and also allergic reactions. Emergence of spots which have rounded shape is characteristic of it. These spots merge in rings. More often the disease develops at young men.
There are also other types erity which are shown at certain pathologies and diseases.
In the course of diagnosis initially the doctor performs inspection of the patient. Laboratory researches are surely appointed. However it is necessary to consider that changes in data of such researches have nonspecific character. But nevertheless with their help it is possible to differentiate an illness, and also to define the reason and an associated disease. The result of clinical blood test at an acute form of a nodal erythema or at recurrence of a chronic disease is noted the raised SOE and a neutrophylic leukocytosis. To define existence in an organism of a streptococcal infection, it is made bakposev from a nasopharynx. If the doctor suspects iyersinioz, the doctor appoints carrying out a bakposev a calla. To exclude tuberculosis, the tuberculinodiagnosis is carried out. At complaints of the patient to the expressed joint syndrome consultation of the specialist rheumatologist and the subsequent blood analysis on a rhematoid factor is necessary.
If there are difficulties in the course of confirmation of the diagnosis, then carrying out a biopsy of one of nodes is possible. In the course of histologic research it is possible to find inflammatory process.
To define an illness origin, existence of vascular disorders, the centers of persistent infection, the patient needs to consult with the infectiologist, the pulmonologist, the otolaryngologist and other specialists. Also in need of process of diagnosis the rinoskopiya, a faringoskopiya, a X-ray analysis and KT of lungs, research of veins, a reovazografiya of the lower extremities, etc. is carried out.
Research of lungs allows to find tuberculosis, a sarcoidosis or other pathological processes in lungs.
Whether there will be a therapy of a nodal erythema effective, directly depends on that, treatment of a basic disease or pathology is how adequate. It is necessary to carry out sanitation of the chronic centers of an infection, if necessary the treatment by antibiotics desensibilizing treatment is appointed. Also reception of vitamins C, P, calcium chloride is recommended. To suspend inflammatory process and to prevent a pain syndrome, with a knotty erythema reception of nonsteroid antiinflammatory medicines is appointed sick. It is a nurofen, diclofenac, an ibuprofen and other medicamentous means. Also methods of extracorporal haemo correction are applied, laser radiation of blood practices. All these methods promote faster fading of symptoms of a knotty erythema.
Also topical administration of corticosteroid, antiinflammatory ointments practices. If there is an inflammation in joints, then bandages with Dimexidum are applied them. The patient with a knotty erythema appoints also physiotherapeutic methods of treatment. Are effective at treatment of a knotty erythema of Ural federal district, a magnetotherapy, fonoforez with a hydrocortisone to the place of the inflamed nodes, laser therapy. But it is the most difficult to treat a nodal erythema during pregnancy as at this time reception of many drugs is contraindicated. In this case accurate control of the specialist is necessary.