erythema nodosum
Introduction
Introduction to nodular erythema Nodular erythema is a painful disease that occurs in young women, nodular vasculitis syndrome, reactive inflammatory disease involving dermal blood vessels and lipid membranes. The skin of the anterior calf is red or purple. A type of nodular change, an autoimmune disease whose nature is non-suppurative nodular erythematous skin lesions. The melon entanglement is similar in the medical literature of the motherland. It is generally considered to be related to infection, especially streptococcal infection and drug reaction. basic knowledge The proportion of sickness: 0.01% Susceptible people: good for young women Mode of infection: non-infectious Complications: leprosy ulcerative colitis lymphoma leukemia Behcet disease
Cause
Nodular erythema
Streptococcal infection (35%):
Some patients can occur in upper respiratory tract infections, angina and acute tonsillitis, reported in two groups in the country, 68.2% with rheumatoid arthritis, 25.6% with tonsillitis, and other reports are very low. This indicates that the disease is associated with streptococcal infection, but it is not the only cause.
Tuberculosis infection (25%):
Since Uffelmana proposed in 1872 that this disease is related to tuberculosis infection, it has gradually attracted people's attention. More and more evidence indicates that this disease is closely related to tuberculosis infection. Domestic statistics also include tuberculosis infection, or old tuberculosis lesions. Or, the positive test of the knot, accounting for more than 60%, the disease is considered to be allergic to the tuberculosis or its toxins.
Other reasons (10%):
Certain drugs, especially bromines and sulfa drugs, are the most common causes of this disease, others such as coccidioidomycosis, histoplasmosis, cat-heating, tickosis, ulcerative colitis, nodules Disease, Behcet's disease, leprosy and sexually transmitted lymphogranuloma may be associated with nodular erythema. In addition, viral infection is associated with this disease. Other rare causes such as acute vulvar ulcers, acute, chronic leukemia, may also be associated with The disease.
The etiology is complex and is generally thought to be related to infections, especially streptococcal infections and drug reactions. Favone and Sosman analyzed 155 cases of EN, and more than 80% of upper respiratory tract infections occurred before symptoms occurred, 50% of which were pharyngitis caused by p-hemolytic streptococcus. Tuberculosis is also an important predisposing factor, especially in children. In addition, viruses, fungi and other infections, bromide, iodide, sulfonamide and other drugs can also induce this disease. Recently, oral contraceptives have been reported.
Pathogenesis
1. The disease is a skin allergic reaction caused by many reasons. The true pathogenesis is still unclear. Some people think that it is an allergic vasculitis, but it is not necrotic or allergic by immunofluorescence technology. Immune complex deposition was found in vasculitis, and some people believe that this disease is a delayed allergic reaction of blood vessels to microorganisms or other antigens.
2. The main pathological changes occur in the subcutaneous fat layer and the subdermal fat leaflet interval. In the early stage of acute inflammatory reaction, mainly neutrophil infiltration, accompanied by a small amount of lymphocytes, eosinophils and a small amount of extracellular extravasation, with As the disease progresses, neutrophils disappear quickly, and instead lymphocytes, plasma cells and histiocytes are infiltrated. In the interstitial space of the fat lobe, giant cells can be seen with obvious fibrin exudation and thickened blood vessel walls. Endothelial cell hyperplasia and luminal occlusion, no abscess and caseous necrosis, the epidermis is generally normal.
Prevention
Nodular erythema prevention
Once you are sick, you should pay attention to bed rest, raise the affected limb to find the cause, and actively eliminate the cause: avoid fatigue and excessive tension; avoid spicy taste, bloody hair, etc.; do not abuse drugs, it is best to choose medication, either Get good curative effect, but also avoid toxic side effects; especially patients with recurrent episodes, should insist on taking traditional Chinese medicine, usually should pay attention to avoid cold and damp; in winter, the author should pay attention to keep warm; reduce walking, especially for long time, long standing.
If the cause is clear, the cause should be removed. If there is tonsillitis and upper respiratory tract infection, effective antibiotics should be given to control the infection. If other causes can be found, they should be removed together. In case of acute attack, bed rest should be carried out to raise the affected limb.
Complication
Nodular erythema complications Complications leprosy ulcerative colitis lymphoma leukemia Behcet disease
The disease may also appear as a concomitant symptom in certain diseases, such as sarcoidosis, leprosy, ulcerative colitis, localized enteritis, lymphoma, leukemia, Behcet's disease, connective tissue disease, etc. It is not entirely clear that some people think that it may be a delayed type of allergic reaction to certain pathogenic microbial antigens; it is also considered to be an immune complex disease.
Symptom
Nodular erythema symptoms Common symptoms Thin tongue white subcutaneous nodules sore throat qi stagnation spleen deficiency lower extremity erythema nodules
The disease occurs in young women, common in spring and autumn, generally symmetrical occurs in the calf stretch, the rash is a number of nodules of varying sizes, bright red or dark red, no ulceration, conscious pain, histopathological manifestations: dermis non-specific inflammation Sexual lesions, vasculitis changes, especially in deep veins.
Nodular erythema is a common nodular skin disease caused by vasculitis. It is common in red or purple-red painful inflammatory nodules on the calf extension. Young women are more common, and the course of disease is limited and easy to relapse. There is a history of infection or medication history before the onset, skin lesions suddenly occur, bilateral bilateral symmetrical subcutaneous nodules, ranging from broad beans to walnuts, the number is up to 10 or more, conscious pain or tenderness, medium hardness, early skin The color is reddish, the surface is smooth, and the surface is slightly raised. After a few days, the skin color turns dark red or blue, and the surface is flattened. After 3 to 4 weeks, the nodules gradually disappear, leaving temporary pigmentation, no ulcers in the nodules. Loss occurs in the front of the sputum, but also in the thigh, upper arm extension and neck, rare in the face, chronic nodular erythema: different from the characteristics of acute nodular erythema: often occurs in elderly women, lesions are unilateral If bilateral, it is asymmetrical, except for joint pain, without other systemic symptoms, nodules are not painful, and softer than acute nodular erythema.
Examine
Nodular erythema examination
Blood routine examination, white blood cell count is generally normal or slightly elevated, but in the early stage, accompanied by high fever, tonsillitis or pharyngitis, white blood cell count and neutrophil count can be significantly increased, rheumatoid factor can also be positive, some people The patient's serum P2 microglobulin was measured to increase.
1. Blood routine and erythrocyte sedimentation rate are generally free of anemia, sometimes white blood cells are elevated, and 2/3 patients have increased erythrocyte sedimentation rate.
2. Immunological examination In the case of tuberculosis, the tuberculin test can be positive.
X-ray examination: When the primary disease is tuberculosis, hilar lymphadenopathy can often be found. The literature reports that young women aged 16 to 30 have nodular erythema and X-ray shows double lymph node enlargement. Known as the Buter syndrome, and considered that these patients have hilar lymphadenopathy, which is actually a manifestation of systemic nodular erythema.
Diagnosis
Diagnosis of nodular erythema
diagnosis
There is typical skin damage, and occurs in young women, nodular erythema suddenly appears in the anterior region of the bilateral tibia, lasts for 1 to 3 weeks, then subsides without leaving any traces. According to the above situation, the disease can be diagnosed.
TCM pathogenesis and dialectic: Chinese medicine believes that there is moisture, stagnation heat, damp heat accumulates in the bloody skin, causing meridians to block, blood stasis and morbidity, or spleen deficiency and moisture, and cold stagnation, cold and damp condensation Blocking the bloodstream.
Dialectical classification of Chinese medicine:
1. Damp heat type main card: sudden onset, headache, sore throat, joint pain or increased body temperature, skin lesions burning, redness, accompanied by thirst, dry stool, yellow urine, reddish tongue, white or greasy tongue , pulse slip micro.
Dialectic: Damp heat accumulation, qi and blood stagnant.
2. Wet and cold type main card: joint pain, aggravation of cold, cold limbs, skin damage color darker red, this ups and downs, repeated lingering unhealed, mouth is not thirsty, stool is not dry or have diarrhea, body temperature does not increase The tongue is light, the tongue is white or greasy, and the pulse is slow or late.
Dialectical: cold and wet condensation, blocking blood vessels.
Differential diagnosis
1. Hard erythema occurs in the flexor of the calf, often single or several, the lesion is larger than the nodular erythema, the disease is long, spontaneous ulceration, ulcer formation, and a certain degree of atrophy after healing.
2. Regression of febrile nodular non-suppurative panniculitis is nodular erythematous lesions, mainly located in the chest, abdomen, thighs, buttocks, into clusters, leaving local atrophy and dishing after disappearance, each episode Both have fever and pathological changes to adipose tissue.
3. Subacute nodular migratory panniculitis is a nodular erythematous rash that occurs in the lower leg. It usually occurs on one side in the early stage of the disease, is painless, is centrifugally enlarged, has a bright red edge, and becomes white at the center. Gradually flattened to form plaques, the size of 10 ~ 20cm, duration of two months to two years, showing hyperpigmentation, also known as migratory nodular erythema, Fine believes subacute nodular migratory Panniculitis and chronic nodular erythema may be different clinical types of the same disease in terms of clinical and pathological features.
4. Nodular vasculitis This disease occurs in middle-aged women. The nodules are mainly located on the lateral and posterior sides of the calf. After a slow, occasional rupture, some people think that the disease is early or light.
