ERYTHEMA KNOTTY (erythema nodosum; Greek erythema redness; a synonym an erythema nodose) — the deep dermo-hypodermal vasculitis proceeding in acute or chronic forms.
The term «erythema knotty» was offered by R. Willan in 1779; the wedge, a picture were in detail described by F. Gebra in 1876
E. at. develops more often at young women as toksiko-allergic reaction at inf. diseases (quinsy, scarlet fever, a brucellosis, tuberculosis, a leprosy, a tinea profunda), sometimes at intolerance of nek-ry pharmaceuticals (streptocides, haloids). AA. at. can accompany a sarcoidosis (see Lefgren a syndrome). The contributing factors are developments of stagnation in extremities, long impact of cold, endocrine disturbances, a hypovitaminosis With and R. Zabolevaniye develops in the spring and in the fall more often.
At E. at. in the fresh centers the inflammatory infiltrate around small vessels of a derma and hypodermic cellulose consisting preferential of neutrophils, to a lesser extent — lymphocytes and histiocytes is noted; an endothelium — in a condition of proliferation. In a late stage of a disease sometimes find epithelial and colossal cells.
Wedge, picture of an acute form E. at. it is characterized by emergence in the thickness of skin of extensor surfaces of shins, is more rare on the hips and forearms symmetrized intense, painful at a palpation, dense, several towering nodes of semi-spherical shape with indistinct edges, from one to several centimeters in size in the diameter. Skin color over nodes in the beginning bright red, then, in process of their permission, cyanotic, chartreuse (change of coloring as «blossoming of bruise»). In
3 — 4 weeks nodes disappear completely or temporarily leave pigmentation and a peeling. Quite often E. at. is followed by fervescence to 38 — 39 °, a fever, joint pains and muscles, the accelerated ROE. The disease can be combined with an exudative mnogoformny erythema (see the Erythema exudative mnogoformny).
At slow development and hron. current E. at. allocate several forms. So, the knotty allergic vasculitis differs in a recurrent current, a small amount is long the existing nodes which are not exposed to disintegration; the migrating knotty erythema of Bie-verstedta proceeds subacutely, and as a result of the peripheral growth and a rassasyvaniye of infiltrate in the center nodes get a ring-shaped form; diffuse infiltrates are characteristic of the subacute migrating hypodermitis single flat, various size and density.
AA. at. at children's age proceeds usually sharply, with disturbance of the general state (feeling of weakness, muscle and joints pain) and high temperature of a body (to 38 — 39 °); are characteristic painful erythematic bonds - lovatye the rashes which are localized on a front surface of shins; separate nodes can merge. More often girls are ill. In some cases at children E. at. can be manifestation of giperergichesky reaction to tuberculosis.
The diagnosis is based on data of the anamnesis and a wedge, manifestations. Differential diagnosis is carried out with the condensed erythema, edges it is observed preferential at young women at hematogenous dissimination of the causative agent of tuberculosis (see Tuberculosis out of internal), and also with a spontaneous panniculitis (see), a lipogranuloma (see), a lipodystrophy (see), hypodermic sarcoids to Darya — Russia (see Darya — Russia sarcoid), calcification of skin (see Calcification) and the migrating thrombophlebitis (see Thrombophlebitis laid down).
Treatment of all forms E. at. carry out by antibiotics of a broad spectrum of activity, drugs of calcium, redoxons and R. Neobkhodim a bed rest. The warm wadded packs warming compresses from 5 — 10% glyceric solution of Ichthyolum are locally recommended. At chronic E. at. also the autohemotherapy, inside — reception of sodium iodide is shown.
Prevention consists in timely treatment of a basic disease.
Bibliography: Tyurin N. A., Myakot-k and N and I. A. and Burkin 3. P. Features of a clinical picture of an acute knotty erythema at children, Pediatrics, No. 3, page 44, 1983; Shaposhni
of O. K k» and D e m e N to about in and N. V * Vascular damages of skin, page 49, JL, 1974; Gertler W. Systematische Der-matologie und Grenzgebiete, Bd 1, S. 580, Lpz., 1970. O. K. Shaposhnikov.