Hard erythema
Introduction
Introduction to hard erythema Erythemainduratum is a cause that is not known to occur in women. It often invades the inner side of the calf below the knees of the lower limbs. It can also invade the lateral side of the calf, the thighs above the knees, and even invade the upper limbs. The head and face are rare. Both sides of the limb symmetry or bright red, or dark red, or purple red nodular damage, tenderness is obvious, generally not itchy. Bazin hard erythema and Wlitfield hard erythema. More common young and middle-aged women. Often with other parts of the body tuberculosis. The tuberculin test was positive, but M. tuberculosis was rarely isolated from the lesion. From the beginning, several subcutaneous nodules of pea size occurred. The multiple symmetry occurred in the lower flexor of the lower leg. After several weeks, the nodule gradually increased. The skin was slightly elevated, dark red, infiltrated, and the boundary was unclear, fixed and hard. basic knowledge The proportion of illness: 0.002% Susceptible people: more common young and middle-aged women Mode of infection: non-infectious Complications: pigmented spots, tuberculosis
Cause
Cause of hard erythema
Disease factor (45%)
Patients are often accompanied by tuberculosis, lymphatic tuberculosis or other organ tuberculosis, tuberculosis-like infiltration of hard erythema, often caseous necrosis, has been considered a skin tuberculosis, but can not find tuberculosis, some scholars believe that hard erythema is A subcutaneous arteriovenous vasculitis that causes fat necrosis, but it is also believed that the onset of hard erythema is released from the blood vessels due to Mycobacterium tuberculosis, initially a local allergic reaction followed by a delayed type hypersensitivity reaction, so the disease may It is a skin immune response that occurs due to a variety of factors that stimulate the body's own immune system.
Age and gender factors (25%)
The cause of scleroderma is unknown, and most of them occur in young women aged 16 to 25 who have flexion of the lower leg. Therefore, the occurrence of this disease is related to age and gender.
Climate factors (15%)
Cold in winter, easy to develop.
Prevention
Hard erythema prevention
1. It is mainly to mobilize the masses, vigorously promote the prevention and treatment of tuberculosis, and conduct regular health checks. If you are sick, you should diagnose it early, treat it early, eliminate the source of infection, and eliminate all kinds of infections. It can also carry out BCG vaccination to enhance the body's resistance.
2, patients should actively supplement nutrition, high protein, low fat, can also give intravenous nutrition, raise the rest of the affected limb.
Complication
Hard erythema complications Complications, pigmented tuberculosis
Part of the hard work gradually softens or ruptures, and the deep ulcer with uneven edges and invagination on the skin is infiltrated around. The base of the ulcer is soft and dark red granulation tissue. The ulcer is not easy to heal, and atrophic scar is formed after healing. The scar is often accompanied by scars. There are pigmentation and hypopigmentation.
Symptom
Symptoms of hard erythema Common symptoms Pigmentation pain Nodular ulcer Skin adhesion granuloma
The main change was tuberculous granulomatous infiltration in the dermis and subcutaneous tissue with caseous necrosis and vascular changes.
Early in the deep and subcutaneous tissues of the dermis, there are tuberculous infiltration around the blood vessels, mainly lymphocytes, epithelioid cells and a few macrophages. There are obvious caseous necrosis, collagen fibers, elastic fibers and fat cells in the infiltrating foci. And necrosis, which is finally replaced by scar formation of fibrous tissue. The arteries and vein walls of the deep and subcutaneous tissues of the dermis are thickened, the endothelial cells are swollen, hyperplasia, and the thrombus is occluded, resulting in a cheese-like necrosis surrounded by lymphocytes.
From the beginning, the skin has deep peas to the hard nodules of the fingers. The number is variable, often several or tens of, ranging in size from several millimeters to several centimeters. The smaller nodules are buried under the skin, and the surface of the skin is not changed. Only palpable, the nodules gradually increase, the larger hard knot is close to the skin surface and adhere to the skin, the inflammation spreads to the skin, the skin surface tends to rise slightly, and becomes red or dark red plaque, the boundary is unclear, the patient No systemic symptoms, only slight tenderness, pain, and after a few months, the induration subsided, leaving reddish brown pigmentation, some nodules merged to form larger plaques, part of the hard work gradually softened or ulcerated, occurred on the skin The deep ulcer with irregular edges and invagination is surrounded by infiltration. The ulcer base is soft dark red granulation tissue. The ulcer is not easy to heal, and atrophic scar is formed after healing. The scar is often accompanied by hyperpigmentation and hypopigmentation.
The disease mainly occurs in young women's calf flexion, hip and other parts also occur by chance, often symmetrical, chronic disease, often the old damage subsided and healed, new damage occurred successively, often hard knots, ulcers, scars and pigments Spots exist at the same time, and in cold seasons, the disease is prone to repeated attacks.
Examine
Hard erythema check
The beginning of hard erythema is several subcutaneous nodules of pea size. The multiple symmetry occurs in the lower flexor of the lower leg. After several weeks, the nodules gradually increase. The skin is slightly elevated, dark red, infiltrating, and the boundary is unclear. hard. Some of the nodules gradually soften and rupture, forming deep ulcers and flowing out thin pus. Local tenderness, etc. Detection of Mycobacterium tuberculosis DNA in parallel hard erythema lesions.
Diagnosis
Hard erythema diagnosis
diagnosis
According to the subcutaneous nodules distributed symmetrically on the lateral side of the calf with tenderness, it can be ulcerated and pathological changes can be diagnosed.
Differential diagnosis
1. Nodular erythema lesions often have nodules on the sides of the calf, the surface of the skin is bright red, no ulcers occur, the nodules have spontaneous pain and tenderness, the course of disease is short, often accompanied by joint pain and fever and other symptoms .
2. Spastic skin tuberculosis often occurs in the neck and upper side of the chest. It usually occurs on one side. It is rarely seen on the flexion of the calf. There is a fistula formation, which is closely related to the lymphatic tuberculosis, bone tuberculosis and joint tuberculosis.
3. Calf red rickets are diffuse symmetry cyanosis in the lower part of the lower leg, no nodules and ulcers occur, often in the cold season, the skin temperature of the affected area is lower than normal skin.
4. The syphilitic gum damage is often asymmetrical, the nodules are hard, the development is faster, the ulcer edge is sharp, the base has necrotic tissue and gum-like secretions, the history of sexual contact, syphilis seropositive.
