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Knotty erythema


Inflammation of skin and the fabric (lipoblasts) located under it as a result of which red painful small knots by the size from cherry to orange are formed.

The knotty erythema can be a symptom of various diseases, but approximately in a third of cases the reason does not manage be established and the knotty erythema is considered as an independent disease.

Symptoms of the Knotty erythema:

Acute knotty erythema - a disease of children's and youthful age; girls are ill much more often than boys, preferential in the fall and in the spring. Emergence of rashes is preceded by the prodromal stage which is shown weakness, an indisposition, subfebrile condition, ostealgias, joints and gastrointestinal frustration. On a current the dermatosis is divided into acute and chronic forms.

At children and teenagers the acute current with a feverish state, rhematoid joint pains and muscles prevails. On an extensor surface of shins, is more rare - hips and forearms quickly arise symmetric, painful at a palpation, dense inflammatory nodes, semi-spherical shape, edematous, intense, the size from a pea to walnut. Nodes slightly tower over surrounding skin, have no clear boundary and differ in lividno-congestive ("kontuziopodobny") coloring. In the course of permission nodes are flattened and periodically change the color as "blossoming of bruise" with transition of a cyanotic erythema in blue-yellowish, greenish and, at last, brown coloring. Nodes never ulcerate, sometimes merge with each other and are resolved in 3-4 weeks without scarring or an atrophy. In certain cases on places of the nodes which were earlier there are a temporary pigmentation and a peeling. Sometimes after permission of one series of nodes arises new that extends a disease up to 6-7 weeks.

The chronic knotty erythema is divided into several clinical versions. To them carry, for example, the migrating knotty erythema with longer current and bent to a recurrence (Bafverstadt type) and a superficial and infiltrative knotty erythema (Wohlstein type). At the first type nodes dense, with indistinct borders, cyanotic-red or brownish-red color, the symptom of "blossoming of bruise" is not observed. The superficial and infiltrative form differs in the big sizes, tendency to peripheral growth and permission in the center with formation of ring-shaped elements. Rashes are followed by the fever, pain and swelling of joints raised by SOE.

Diagnosis. Pay attention to plurality and symmetry of nodes, the characteristic cyanotic shade evolving "blossoming of bruise", permission of nodes without disintegration and an ulceration.

Histopathology. In small vessels of skin (capillaries and arterioles) the gleam is narrowed up to their full obliteration due to proliferation of an endothelium. Around vessels intensive perivascular infiltrate from lymphocytes, neutrophils and histiocytes; places of accumulation of epithelial cells and fibroblasts. In a mesh layer of a derma endothelial proliferation in arterioles, venules and capillaries, puffiness of a connective tissue stroma.

Reasons of the Knotty erythema:

The knotty erythema meets at such diseases:
- Tuberculosis
- Streptococcal infections
- System lupus erythematosus
- Pseudorheumatism
- Ulcer colitis
- Disease Krone
- Tumoral diseases
- Pregnancy

Treatment of the Knotty erythema:

At an acute form at children of younger age special attention is paid to detection of a tuberculosis infection and carry out the corresponding treatment. At children of advanced age careful inspection is directed to a focal infection, rheumatism. In the absence of instructions appoint antibiotics of a broad spectrum of activity to tuberculosis. Widely use calcium a gluconate or chloride, Naprosinum, saditsi-armor, Rheopyrinum, Pyrabutolum, Brufenum.

Appoint aminocapronic acid in 5% solution on 1 tea or a dessertspoon 3-4 times a day within 10 - 12 days or Ambenum in syrup on 1 teaspoon 2-3 times a day to children from 1 year to 3 years of willows tablets (0,25 g), on 1 - 2 tablet 2-3 times a day within 7-10 days.

In persistent cases with the expressed inflammatory reaction and in the absence of tuberculosis together with antibiotics appoint glucocorticoid hormones (Prednisolonum from 10 to 20 - 30 mg, Urbazonum on 8-16-24 mg, dexamethasone on 2-3 mg a day) with the subsequent gradual dose decline in process of process improvement, and also antimalarial drugs (Resochinum, delagil) on 0,05-0,1 g to children up to 3 years and for 0,125 - 0,25 3 years 1-2 times a day cycles for 3-5 days under control of morphology of blood are more senior.

Recommend vitamins: Rutinum, ascorbic acid, Aevitum, vitamins In and Bi2, - an autohemotherapy. In the absence of data for tuberculosis and other contraindications appoint radiation a mercury-quartz lamp, a diathermy, соллюкс, UVCh-therapy.

Outwardly apply compresses from 5-10% of solution of Ichthyolum, Aceminum ointment, Mikulich, Vishnevsky or Krede's resorptional ointments

Recommend a bed rest and a diet. The forecast is favorable.

Drugs, drugs, tablets for treatment of the Knotty erythema:

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