What it looks like and how it works
The disease usually begins with malaise, fever and joint pain, and after a few days nodules the size of a cherry to a walnut appear on the legs. The skin over them is bright red, hot, the touch is painful, and in the evening the legs swell. The nodes are located symmetrically, most often along the front surface of the legs, less often on the thighs and forearms. After one or two weeks, they flatten and change color from red to bluish, then to greenish-yellow - hence the comparison with a bruise. There are no ulcers or scars left.
- Painful tight nodes on the legs
- Symmetrical arrangement
- Redness and local fever
- Fever and joint pain
- Change in color like a bruise
- Healing without scars
Reasons
In a significant proportion of patients, the cause cannot be found, and then they speak of the idiopathic form. Of the established causes, the leading ones are infections, primarily streptococcal tonsillitis, suffered 2-3 weeks before the rash. A reaction is also possible with tuberculosis, yersiniosis, and some fungal infections. The second large group is systemic diseases: sarcoidosis, inflammatory bowel diseases, and less commonly Behcet's disease. Erythema nodosum can be triggered by medications, including some antibiotics and combined oral contraceptives, as well as pregnancy.
- Streptococcal infection
- Tuberculosis
- Sarcoidosis
- Crohn's disease and ulcerative colitis
- Intestinal infections, including yersiniosis
- Drug reactions
- Pregnancy
- Idiopathic form
Survey
The diagnosis of erythema nodosum is usually made clinically, and efforts are directed towards finding the cause. A complete blood count, ESR and C-reactive protein, ASLO, and a throat swab are ordered to evaluate streptococcal infection. A chest x-ray is required: enlarged intrathoracic lymph nodes indicate sarcoidosis, and changes in the lungs indicate tuberculosis. An examination for tuberculosis is carried out; in case of intestinal complaints, a stool examination and a consultation with a gastroenterologist are carried out. If the picture is atypical, the nodes are opened or do not go away for more than two months, a deep biopsy is performed.
- Complete blood count and ESR
- C-reactive protein
- ASLO and throat swab
- Chest X-ray
- Testing for tuberculosis
- Stool tests for intestinal complaints
- Biopsy of a node with an atypical course
Treatment
The main direction is treatment of the identified cause: an antibiotic for a confirmed streptococcal infection, specific therapy for tuberculosis, treatment of the underlying disease for sarcoidosis and inflammatory bowel diseases, discontinuation of the suspected drug in consultation with the doctor. Rest, elevated position of the legs, non-steroidal anti-inflammatory drugs, and elastic compression are symptomatic. You should not walk or stand for a long time during the acute period. In severe or protracted cases, the doctor may prescribe systemic medications, including glucocorticosteroids, but only after ruling out infection.
- Treatment of the underlying disease
- Rest and elevated position of the legs
- Nonsteroidal anti-inflammatory drugs
- Compression jersey
- Discontinuation of the provoking drug in consultation with the doctor
- Systemic therapy for severe cases
- No warm compresses unless prescribed
Forecast and observation
In most cases, the nodules completely resolve within 3–6 weeks, leaving no scars, although pigmentation may last longer. Weakness and pain in the joints sometimes persist for several weeks after the rash disappears. Relapses are possible, especially with chronic infection in the tonsils, inflammatory bowel diseases and sarcoidosis, so it is important to treat the underlying cause and undergo observation. If the rashes recur, new complaints from the lungs, intestines or joints appear, the examination is repeated: the cause may not appear immediately.
- Resorption in 3–6 weeks
- Pigmentation lasts longer than knots
- Relapses are possible
- Observation by a dermatologist and therapist
- Repeated examination for relapses
- Sanitation of foci of chronic infection