home Audience 1 Chronic erythema nodosum on the legs. Erythema of the lower extremities is nodular. Acute and chronic course of the disease

Chronic erythema nodosum on the legs. Erythema of the lower extremities is nodular. Acute and chronic course of the disease

There are many cases where characteristic red rashes were found after suffering from a sore throat, taking certain antibiotics, sulfa drugs, contraceptives and iodine.

Doctors do not deny the influence of the hereditary factor. Chronic infections (tonsillitis, pyelonephritis, sinusitis) and diseases of allergic origin can also cause the development of this disease.

Erythema often affects people with diseased blood vessels.

It can also result from:

tuberculosis;
sarcoidosis;
leukemia;
lymphogranulomatosis;
streptococcal infection (scarlet fever, streptoderma);
venous diseases;
fungal infection;
rheumatoid arthritis;
lupus erythematosus;
nonspecific ulcerative colitis;
less often - cancer or leprosy.

Factors contributing to the development of the disease in pregnant women are disturbances in the functioning of the endocrine organs, blood stagnation in the lower extremities, prolonged exposure to cold, seasonal weather changes, and hypertension.

Causes

The disease can be either idiopathic, i.e. independent, or a consequence of previously suffered diseases. Causes of the disease:

There are studies that prove that erythema is nothing more than a variant of the course of vasculitis of an allergic nature. Many patients are interested in what it is. With this disease, local vascular damage occurs. As a rule, such damage occurs on the legs.

This diagnosis is made to people of any age category. The prevalence of this disease before the onset of puberty is almost the same in males and females. After puberty, the disease is more common in women than in men.

Acute and chronic forms develop for the following reasons:

The main impetus for the development of acute erythema nodosum is respiratory, as well as acute viral disease. Many cases are marked by the appearance of spots with a rise in body temperature and poor health. The disease is characterized by unpleasant sensations in the joints of the legs.

Erythema nodosum can be physiological and appear after various effects on the skin. The cause of erythema nodosum is massage, rubbing the skin with warming creams, as well as alcohol tinctures.

Sometimes the disease erythema nodosum appears after taking medications, but there are cases of appearance after nervous, intense stress. The disease loves workaholics, who often experience nervous strain.

However, often the causes of acute erythema nodosum are tuberculosis bacillus, coccal infection and yeast-like pathogens.

The main reasons for the progression of erythema nodosum in humans have not yet been precisely established. Scientists suggest that the hereditary factor plays an important role in the development of this pathology.

They also note that in some clinical situations, erythema nodosum is a nonspecific immunoinflammatory syndrome. Infectious and non-infectious causes can provoke the manifestation of pathology.

Non-infectious causes:

The term “erythema nodosum” was introduced in 1807 by Robert Willan, a British dermatologist. Research by scientists has proven that erythema nodosum is one of the variants of allergic vasculitis.

In most patients, local damage to the vessels of the lower extremities accompanies the course of various diseases. Sometimes erythema manifests itself as an independent pathology.

The main cause of the disease is various types of infections. The most common pathogen is streptococcus.

Erythema nodosum accompanies:

give birth;
sore throat;
otitis;
acute pharyngitis;
rheumatoid arthritis;
streptoderma;
cystitis;
yersiniosis;
inguinal lymphogranulomatosis and others.

Doctors still cannot explain exactly why primary erythema nodosum develops in humans. And the majority is inclined to believe that heredity - genetic predisposition - is to blame for everything.

People with the following ailments are prone to a chronic course of the disease:

vascular diseases (varicose veins, thrombophlebitis and atherosclerosis of the lower extremities);
allergic diseases (bronchial asthma, dermatitis, hay fever);
chronic infectious diseases (tonsillitis, sinusitis and pyelonephritis).

Secondary erythema has various causes; its development can be triggered by the following factors:

Classification of the disease and its symptoms

As already noted, erythema can be acute or chronic. The chronic type of the disease has two types:

migrating (with this form, dense nodes have blurred boundaries, they are usually bluish or red);
superficial nodular (the nodes in this disease are very large, and the appearance and development of such objects is accompanied by skin rashes, fever, pain and an increase in the erythrocyte sedimentation rate).

This is the most common classification of the disease and is used most often. Idiopathic erythema is spoken of when its cause cannot be determined.

Symptoms of the disease

The disease is caused by the appearance of a hyperergic reaction to medicinal and bacterial allergens. And the main places where the rashes are concentrated are the front and side surfaces of the lower leg.

The condition of a patient with erythema nodosum is aggravated by chronic diseases. These are dental diseases, tonsillitis, tuberculosis, otitis media, and other viral infections.

Erythema nodosum falls under the category of independent disease when it is difficult to find out the cause.

Characteristic signs of vascular pathology:

How does a sick person feel? The main symptoms of this disease:

bad feeling;
weakness;
chills;
fever.

Nodular seals form on the second or third day after the patient begins to feel unwell. As a rule, the area of distribution of nodes is the anterior and lateral surface of the lower leg.

But there are cases when erythema nodosum is observed not only in the lower regions of the legs, but also on the thighs, arms, and forearms. Almost always, dense nodules are located symmetrically.

Diagnostics

Basic diagnostic methods for suspected erythema nodosum:

blood analysis;
bacteriological culture;
nodule biopsy;
CT scan;
rheovasography;
Doppler ultrasound examination of the venous vessels of the lower extremities.

The most informative is histological examination. With its help, it can be established that the inflammatory reaction is localized in the subcutaneous tissue and in the lower layers of the dermis. Necrosis and tissue abscess are not diagnosed.

Differential diagnosis is very important, as it allows you to more accurately determine the presence of erythema. It makes it possible to identify the causes of erythema and outline possible treatment methods. The diagnosis can be made only after conducting a set of necessary studies.

There are the following methods for diagnosing the disease:

Culture for bacteria from the nasopharynx area. Usually it allows you to determine whether the patient has streptococci.
Diagnostics are carried out to exclude the presence of tuberculosis infection in a person.
A blood test for rheumatoid factors can establish or exclude the presence of rheumatic joint disease.
A node biopsy is usually prescribed in difficult situations that make diagnosis difficult.
Consultation with specialized specialists such as a pulmonologist, infectious disease specialist, phlebologist, vascular surgeon, etc.
Rhinoscopy.
Pharyngoscopy.
Ultrasound of the veins of the lower extremities.
X-ray examination of the lungs.

Such a thorough diagnosis allows you to determine treatment in adults and children. You should not refuse all necessary examinations, since recovery depends on them.

Diagnostics includes laboratory and instrumental examination methods:

Choosing the right type of therapy is difficult. Nodular rashes of various sizes are symptoms of many pathological processes in the body.

Diagnosis is quite specific. Tests are required to exclude or confirm the presence of underlying diseases. The list of “suspects” is wide – from tuberculosis to otitis media.

Mandatory studies:

bacterial culture from the nasopharynx;
blood test for rheumatoid factor;
tuberculin diagnostics;
pharyngoscopy;
computed tomography of the lungs;
a detailed blood test to determine the level of SES;
stool culture;
rhinoscopy;
X-ray of the lungs;
Doppler ultrasound of the veins of the lower extremities.

The unknown origin of the formations requires a biopsy of the nodes. Histology reveals the degree of development of the inflammatory process.

The effectiveness of therapy depends on the results of treatment of the cause of the inflammatory process and the elimination of associated pathologies. Good results are achieved by combining:

medicines;
physiotherapy methods;
traditional medicine recipes.

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If erythema nodosum appears, who treats this disease? First of all, you need to contact a dermatologist, because this is a skin pathology.

Although the signs of erythema nodosum are obvious, the doctor will always prescribe additional tests, such as:

Blood analysis.
Bacteriological culture.
Biopsy of the contents of the nodules.
Examination under a microscope.

If necessary, the patient may be referred for Doppler ultrasound of the vessels of the legs. To find out the cause of the disease, consultations with other specialists will be needed.

Differential diagnosis is a diagnosis that, based on facts or symptoms, excludes diseases and, in the end, leads to the formulation of a single correct diagnosis.

Erythema nodosum can be confused with the following diseases:

Thrombophlebitis. In this case, the disease also forms compactions that are painful when pressed, but they are localized along the veins and have a tortuous appearance. The patient complains of muscle pain, legs swell. If the blood clot becomes infected, then intoxication of the body occurs - the patient suffers from weakness and high fever.
Erysipelas or erysipelas is an acute infectious disease caused by streptococcus. There is a sharp rise in temperature to 38–39 °C and weakness. Then burning and pain in the affected areas, which swell over time. The area of redness has jagged edges, rises above healthy skin, and feels hot and tight to the touch. Sometimes bubbles form that are filled with liquid. Unlike erythema nodosum, erysipelas is characterized by inflammation of the lymphatic vessels and nodes.
Erythema of Bazin or indurative tuberculosis. Rashes form on the back of the lower leg. Nodes form slowly. They do not become inflamed and do not rise above healthy areas. The skin over them has a blue-red color, which does not tend to change. However, the nodes can turn into ulcers and leave behind scars.
Christian-Weber disease. Characterized by inflammatory processes in subcutaneous fatty tissue. Small subcutaneous lumps form on the forearms, thighs and torso, which are moderately painful when pressed.

Erythema nodosum always requires diagnosis to be confirmed. The first thing you need to do is a blood test, which determines the increased number of leukocytes and ESR.

If a bacteriological culture is carried out from the nasopharynx, a streptococcal infection is often isolated. If articular syndrome is present, then this is a reason to go to a rheumatologist.

If the diagnosis cannot be made based on clinical signs, then a biopsy of one of the nodules on the legs has to be performed. In order to understand what caused the disease, consultation with many specialists and studies such as:

Rhinoscopy.
Pharyngoscopy.
X-ray of the lungs.
Rheovasography.
Ultrasound scanning of the leg veins.

Once the cause of the disease has been identified, treatment can begin.

Treatment of the disease

Therapy for erythema involves treating the underlying cause of the disease. Treatment of erythema nodosum is based on the use of combination therapy.

Patients are reduced the load on the lower extremities and recommended bed rest. Salicylates are prescribed (Askofen, Aspirin), and it is mandatory to take antihistamines - Suprastin, Zyrtec, Diazolin, Telfast, Tavegil or Claritin.

The main principles of treatment for this disease are as follows:

Sanitation of chronic infectious foci.
Antibiotic treatment (carried out only after preliminary general diagnosis).
Prescription of non-steroidal anti-inflammatory drugs. The most commonly used are Nimesil or Indomethacin, Brufen.
Hormonal drugs. These include, for example, Prednisolone.
Hemocorrection.
Laser therapy.
Phonophoresis.
Treatment of affected joints (with hydrocortisone).

Such a disease is unlikely to allow a person to perform any physical types of work. The disease is usually treated in a hospital setting. Bed or semi-bed rest is recommended.

Many patients are interested in whether sports are allowed during or after recovery. After such an illness, you must exclude any sports activities and training for a period of one month.

Drug treatment for such a disease is quite serious, because the list of drugs prescribed for erythema is significant. The patient cannot prescribe such medications for himself; he must consult a doctor. Let us note the most common medications, in addition to those listed above:

desensitizing drugs (taken if the body has allergies);
acetylsalicylic acid preparations;
vitamin preparations (especially groups B, C);
Rutin, Askorutin;
angioprotectors;
anticoagulants (in particular, heparic acid).

Treatment using traditional methods

Sometimes treatment with folk remedies can be practiced. First of all, this treatment involves a certain diet. You need to add grains, beans, and greens to your diet. To combat edema, diuretics are prescribed.

It should be noted that they are not the only means of treating erythema nodosum, but only complement what the doctor prescribed. Of course, if you practice this type of therapy, it can only alleviate the condition, and not cure the person completely.

After visiting a doctor, the patient will be prescribed an x-ray of the lungs to rule out tuberculosis and sarcoidosis, and will be recommended to do a smear for streptococcus and a test for Yersinia. To exclude infections, various blood tests will be prescribed.

Treatment of erythema nodosum should only be carried out by a highly qualified specialist. If the doctor was able to determine which disease provoked the development of the pathology, then first of all, it is necessary to begin treating it.

If erythema nodosum has developed against the background of an infectious disease, then antiviral, antibacterial and antifungal drugs are prescribed.

For the primary form of pathology, the following drugs are prescribed:

antihistamines;
non-steroidal anti-inflammatory drugs;
aminoquinoline drugs;
corticosteroids.

For local treatment, it is recommended to use anti-inflammatory ointments (including hormonal ones) and make compresses. Physiotherapy also has a good effect in treating the disease. Laser therapy, phonophoresis, magnetic therapy, and ultraviolet radiation are prescribed.

As an additional therapy, you can use folk remedies, but only after agreeing with your doctor. Uncontrolled use may not only not help, but also aggravate the course of the disease.

Folk remedies for the treatment of erythema nodosum:

Long before the advent of medicine, nature made sure that a person could speed up recovery with the help of medicinal plants. Modern medicine does not refute the fact that treating erythema with folk remedies can give positive results.

However, before using them, it would be much wiser to first consult with your doctor.

Erythema nodosum treatment involves complex treatment. Therapy is carried out in the following areas:

Medical treatment.
Physiotherapeutic procedures.
Traditional medicine recipes.

Need to know. When selecting treatment tactics for a patient, the doctor must take into account that it should not only relieve the manifestations of the disease, but also eliminate provoking factors.

How to fight a disease with medications

Complex drug treatment involves the use of the following means:

If the pathology develops as a result of an existing inflammatory disease, then the use of antibacterial drugs, for example, Penicillin, Tetracycline, is indicated.

Advice. The pathology will recede faster if you also take Prednisolone along with antibiotics.

Ointments or creams that have anti-inflammatory properties and accelerate tissue repair are prescribed externally. If erythema nodosum appears in children, then you can use Vishnevsky ointment, “Acemin”.

Therapy with non-steroidal anti-inflammatory drugs - Ibuprofen is suitable.
To eliminate the allergic factor, the use of antihistamines (Tavegil, Suprastin) is indicated.
If the disease is chronic, then the treatment must be supplemented with aminoquinoline drugs, for example, such as Delagil or Plaquenil.
To restore blood vessels, the use of angioprotectors (Trental, Aescusan) is indicated.

Painful manifestations of the disease can be removed with the help of laser irradiation, hemosorption.

Treatment with physiotherapeutic methods

Physiotherapy is an excellent addition to drug therapy. The following procedures are prescribed to patients:

Magnetotherapy.
Phonophoresis with Hydrocortisone.

Laser treatment.
Diathermy.
Compress with ichthyol solution.

Treatment usually ends with the prescription of immunomodulatory agents and vitamin preparations.

Important. If erythema is found in a woman during pregnancy, then all treatment should be strictly under the supervision of a physician. You cannot prescribe medications for yourself.

Traditional medicine against erythema

When such a pathology appears, many people wonder how to treat erythema nodosum at home. We can recommend using the following recipes from traditional healers:

Treatment is prescribed and carried out by a specialist after identifying the exact cause of the disease:

To relieve general symptoms, antihistamines, as well as a number of pharmacological agents of a number of salicylates, can be prescribed. Depending on the tests and reasons, antibiotics are prescribed.
Skin lumps are treated with anti-inflammatory and hormonal ointments, which are prescribed by the doctor for each case individually.
Physiotherapeutic methods include phonophoresis, warming compresses, and UHF.

Girls are more susceptible to this disease than boys. Erythema nodosum is most often diagnosed in children over 6 years of age.

At the same time, the child becomes very whiny and capricious, complains of pain in the abdomen and joints, red spots of different sizes and very painful nodes form on his legs.

The limbs swell, the pain intensifies with movement.

Anti-inflammatory drugs Aspirin, Brufen, Indomethacin are used to treat children. Warming compresses with heparin or ichthyol ointment are placed on the area of the rash.

As for erythema in expectant mothers, it is absolutely safe for the fetus. But the woman’s health is at risk because the disease can cause complications in the heart. For the treatment of erythema nodosum during pregnancy, the following is prescribed:

lubrication of the affected areas with Indovazin ointment, Dip-relief ointment;
the minimum dosage of Paracetamol;
to reduce inflammation - Aspirin (in the smallest doses);
Curantil tablets;
in severe cases - Diclofenac injections;
Antibiotics may also be prescribed (usually macrolides or cephalosporins), but only in the 2nd trimester.

Important! If signs of erythema appear in a child or expectant mother, then making a diagnosis on your own, much less engaging in treatment (even with herbs), is strictly prohibited! This can lead to unpredictable consequences.

The patient should definitely reduce the load on her legs, but, of course, she should not lie in bed all day.

Complications and consequences

The lack of proper therapy will provoke the chronic stage of the disease. You shouldn’t think that in a month or a month and a half “everything will go away on its own.” A full examination and treatment of manifestations of erythema is mandatory.

Do not forget that formations on the skin are a sign of internal problems. Untreated underlying diseases eventually develop into a more dangerous form with serious consequences.

Preventive measures

Prevention of the disease, as a rule, comes down to timely consultation with a doctor if certain health problems arise. If there are foci of infection, their complete sanitation is necessary. It is important to lead a healthy lifestyle, alternating physical activity with rest.

This pathology does not pose a health hazard, because the nodes tend to resolve. But still, it must be treated in order to prevent the development of a chronic form.

People prone to the formation of erythema nodosum need to be attentive to their health and promptly contact specialists when the first symptoms of trouble appear.

Basic Rules:

monitor the condition of the vascular system;
take action at the first signs of varicose veins;
avoid contact with allergens;
undergo regular medical examinations;
treat chronic diseases.

Erythema nodosum on the legs is a serious disease. Use the entire arsenal of remedies suggested by your doctor. With an integrated approach to treatment, the prognosis is favorable.

Changes in blood vessels often lead to such a painful condition as erythema nodosum of the lower extremities. This disease requires careful identification of the causes, as it may be a consequence of serious changes in the body.

What is erythema nodosum?

Inflammatory changes in small vessels of the skin and subcutaneous tissue, which are of an autoimmune nature, can develop at any age: from childhood to the elderly, but most often erythema affects young people (from 20 to 40 years).

Statistics show that women suffer from the disease 6 times more often than men. The onset of the disease occurs in most cases in spring or winter and represents limited vascular damage.

Causes

Inflammatory vascular infiltrate can have different etiologies.

Non-infectious

Pathological changes in the body that are not associated with the development of an infectious process that can cause the appearance of erythema nodosum on the legs may be as follows:

sarcoidosis;
inflammatory and ulcerative changes in the large intestine (colitis, Crohn's disease);
hereditary predisposition;
pregnancy;
oncological diseases of benign and malignant etiology (leukemia, lymphogranulomatosis);
vein diseases (varicose veins, thrombophlebitis), atherosclerotic vascular lesions.

Pregnant women are at risk for the disease, as erythema appears much more often in them. This is due to changes in hormonal levels and an increase in the overall reactivity of the body.

In some cases, erythema may be caused by an allergic reaction to the following medications:

antibiotics;
sulfa drugs;
acetylsalicylic acid;
solutions of iodine and bromine salts.

Since the disease is of an allergic nature, people with certain diseases (hay fever, urticaria, bronchial asthma) are predisposed to it. Sometimes the process begins after a routine or emergency vaccination.

infectious

The causes of erythema nodosum of the lower extremities are often associated with infectious diseases. The disease occurs against the background of the following conditions:

chronic and acute foci of streptococcal infection (tonsillitis, otitis, cystitis, pyelonephritis, tonsillitis, streptoderma, erysipelas);
tuberculosis;
fungal infections (histoplasmosis, coccidioidomycosis);
yersiniosis;
viruses (Epstein-Barr, hepatitis B, cytomegalovirus);
sexually transmitted diseases (syphilis, gonorrhea).

Erythema nodosum is not contagious to others, since its pathogenesis is associated with the individual reaction of the body. If there is an infectious agent in the body, its carrier can become a source of infection and provoke the occurrence of other diseases of a similar nature.

Pathological changes in pathology

Erythema nodosum on the legs is associated with the development of an inflammatory process in the blood vessels. The endothelial layer of the wall of a vein or artery thickens and swells, and an infiltrated compaction appears in it with an accumulation of lymphocytes and eosinophils. Inflammation is most active in the first 2-3 days of the disease.

As the process progresses to the chronic stage, histiocytes, plasma cells and giant cells appear at the site of inflammation. Fatty tissues and blood vessels are infiltrated by these elements, and even small abscesses can form.

Pathological changes in blood vessels and fat layer are subsequently transformed into connective tissue formations. The epidermis and upper layers of the skin are not involved in the inflammatory process.

Symptoms

The appearance of painful symptoms is associated with the severity of pathological changes and the nature of the disease.

Acute erythema nodosum

This form is characterized by the appearance of dense subcutaneous nodes in the area of the legs, knee or ankle joints, and feet. The color of the skin at the site of the lesion becomes red, subsequently changes to bluish, and then to light yellow. The size of the formations can range from 0.5 to 5 cm, they can be single or located symmetrically on two legs. As the process actively develops, the nodes and redness increase, and pain may occur when pressing on them.

After 3-4 weeks, the erythema regresses, leaving no scars or atrophy.

Nodules on the skin are accompanied by a deterioration in health with an increase in temperature to 37-39 degrees, headache, and discomfort in the joints and muscles. A blood test reveals changes (increased white blood cell count and ESR) characteristic of inflammation.

Acute erythema is most common in young adults and children.

Migratory form

It occurs subacutely, with a moderate increase in temperature. Pain in joints and muscles is mild. A compaction with a clear boundary appears on the anterolateral surface of the leg. The edges of the formation acquire a bright red color, and a paler depression forms in the center. The node may be a single one, and after some time a similar infiltrate appears in another place. After 2-3 months of illness, the plaques regress.

Chronic form

A course without pronounced inflammatory changes is typical for middle-aged and elderly women suffering from chronic infectious and oncological diseases.

Seals on the skin appear in typical places; they can be identified during palpation. The color of the skin over the formations does not change, manifestations of intoxication are absent or only slightly expressed.

Specifics of pathology in certain categories of patients

In childhood and in pregnant women, the course of erythema nodosum has its own characteristics.

In children

Most often, the pathological process is diagnosed in children after 6 years of age. Girls are more susceptible to the disease than boys.

Young patients, as symptoms progress, behave restlessly and excitedly, complaining of pain in the joints and abdomen. To cope with the disease, it is necessary to establish the exact cause.

Erythema nodosum in children in the vast majority of cases develops against the background of an infectious process in the body. The child requires mandatory hospitalization for diagnosis and effective treatment.

During pregnancy

In pregnant women, a special role in the development of the pathogenesis of the disease is assigned to the vessels, which are subject to significant stress during gestation. An increase in the overall reactivity of the body, which can manifest itself in the form of allergic vasculitis against the background of the presence of an infectious pathogen, is also important.

Diagnostics

Additional examination methods make it possible to find out the exact cause of the disease.

To exclude tuberculosis and sarcoidosis, it is necessary to take an x-ray of the chest organs, and in complex cases, a computed tomography will be required.

Indicators of a clinical blood test determine the degree of intensity of inflammation (leukocytes and ESR), as well as the nature of the infectious process (an increase in lymphocytes indicates a viral etiology, neutrophilia indicates a bacterial infection). A blood test can exclude leukemia and lymphogranulomatosis.

To confirm inflammation in the vessels and subcutaneous fat, a biopsy of the skin and subcutaneous layer of the affected tissue will be required.

The following tests are also required:

a throat swab to detect streptococcus in the tonsils;
blood test using the Wasserman reaction (test for the presence of syphilis);
bacteriological culture of stool to determine the presence of Yersinia;
rheovasography.

Treatment of erythema nodosum is carried out by a dermatologist, but to clarify the diagnosis, consultation with other doctors will be required:

Additional examination by specialized specialists is necessary to clarify the nuances of the disease and select adequate treatment.

In some situations, it is not possible to find out the direct cause of the pathology - such a condition is recognized as having arisen independently.

Treatment

Treatment measures should be aimed at eliminating the main cause of erythema nodosum. If a focus of streptococcal infection is detected, a course of antibiotic therapy is prescribed with the following means:

Penicillin;
Streptomycin;
Amoxicillin;
Tetracycline;
Ceftriaxone.

Against the background of antibacterial therapy, treatment with anti-inflammatory non-steroidal drugs is necessary:

Diclofenac;
Indomethacin;
Ibuprofen;
Celecoxib.

Steroid hormonal drugs have the most rapid effect:

Prednisolone;
Dexamethasone;
Hydrocortisone.

Despite the fact that corticosteroid drugs have a powerful anti-edematous, anti-allergic and anti-inflammatory effect, their use is limited in a number of patients (children, pregnant women, the elderly) due to a number of side effects.

The most effective means

The most pronounced clinical effect is achieved by local use of anti-inflammatory ointments based on Ibuprofen, Diclofenac and Indomethacin.

Experts often prescribe compresses with Dimexide diluted with water 1:3. This remedy has the ability to penetrate deeply into tissues and have a powerful anti-inflammatory effect.

Taking antihistamines can relieve an allergic reaction. Fenistil ointment is recommended for topical use, and the following medications are taken orally:

Tavegil;
Suprastin;
Claritin;
Cetrin;
Loratadine.

For circulatory disorders in the vessels of the legs, the following medications are indicated:

Pentoxifylline (trental);
Dipyridamole (chimes);
A nicotinic acid.

A severe inflammatory process with an autoimmune component requires the administration of aminoquinoline drugs (Delagil, Plaquenil).

Help from traditional medicine

In addition to complex treatment using traditional methods, alternative medicine can be used topically after consultation with your doctor.

Lotions and compresses made from the following medicinal plants give good results:

oak and white willow bark;
forest raspberry and lingonberry leaves;
linden and elderberry flowers;
St. John's wort, yarrow;
chamomile and calendula.

An ointment made from arnica root powder gives a good effect.

If hypersensitivity to these drugs occurs, treatment should be stopped immediately.

Disease prognosis

In most cases, under the influence of properly selected treatment, complete regression of erythema nodes is observed. No atrophic skin changes are observed. In the absence of adequate therapy, there is a risk of relapse of erythema.

Possible consequences and complications

Under unfavorable conditions, the following complications are possible:

the appearance of a cosmetic defect;
ulceration of the skin at the site of the nodular seal;
progression of diseases that caused the appearance of erythema.

For effective treatment, it is necessary to carefully diagnose the state of the immune system and the presence of concomitant pathologies.

Prevention

To prevent the development of erythema nodosum and its relapses, the following rules should be followed:

increase the body's resistance and promptly sanitize foci of chronic infection;
avoid hypothermia and prolonged standing;
wear comfortable shoes made of high-quality materials with low heels;
monitor the condition of the venous and arterial systems.

Since erythema nodosum often occurs in women during pregnancy, special attention should be paid to the state of the immune, vascular and endocrine systems.

In recent decades, there has been an unpleasant trend of increasing the number of people suffering from various skin diseases. No one is yet able to give a reliable explanation for this phenomenon. Among problems such as eczema, papillomas, age spots, acne and rashes, there is also a rather rare disease - erythema nodosum. What it is, what it looks like, why it is dangerous and how to treat it - read below.

Erythema nodosum is a fairly rare occurrence.

What disease is erythema nodosum?

Erythema nodosum on the legs is an inflammatory skin disease caused by the formation of painful subcutaneous lumps on the legs and in places where adipose tissue accumulates. Usually localized in the deep layers of the epithelium and fatty tissue, it leads to inflammation of the subcutaneous blood vessels.

The first mention of the term “erythema nodosum” dates back to 1807. The name was introduced by British dermatologist Robert Willan. Later, more detailed studies of the nature of the disease were carried out, which made it possible to identify erythema as a group of allergic vasculitis.

The disease manifests itself en masse or individual compactions are observed (usually symmetrically located). A larger percentage of formation sites occur in the lower extremities. People aged 20 to 35 years are susceptible to the disease. Among the patients there are more young women. Adult men suffer from erythema three times less often. However, among adolescents of both sexes during puberty, the frequency of visits to a dermatologist with the problem described above is equally equal.

Erythema nodosum most often affects women

Causes of the disease

It was found that erythema nodosum is a disease based on an allergic nature. The main causative agent of inflammatory processes that triggers the formation of compactions under the skin is infection. The development of the disease is observed against the background of tonsillitis, otitis, pharyngitis, scarlet fever. Although to a lesser extent, the following factors can provoke the disease:

taking antibiotics, iodides, bromides;
allergy to sulfonamides;
consequences of vaccination;
sarcoidosis;
intestinal ulcerative colitis;
oncology;
Behçet's disease;
pregnancy period, subject to the presence of chronic infectious processes in the body;
inguinal lymphogranulomatosis;
leprosy.

It has also been noted that in one family, erythema nodosum of the lower extremities can recur in several generations. Therefore, the factor of genetic disposition or heredity is additionally distinguished.

Types of erythema nodosum

A classification of types of erythema has been developed depending on the causative agent of the disease and the clinical picture. This division will allow you to make the most accurate diagnosis and select the appropriate treatment.

The following types are distinguished:

Toxic

Typical for newborns. Refers to the physiological norm, which manifests itself in the first days of life in the form of skin rashes. There are no other symptoms other than external ones. Treatment of toxic erythema is not required, since the formations disappear on their own within a week.

Erythema nodosum toxicum occurs in newborns

Infectious

Accompanies infectious diseases of unknown etiology. The main pathogen is streptococci. It is observed in people of all ages and gender.

Multiform exudative

Subcutaneous lumps appear and progress against the background of colds. Erythema nodosum is accompanied by symptoms similar to acute respiratory viral infection: headache, weakness, malaise, sore throat and joint pain. Painful nodules appear on the palms and arms, feet, legs, mucous membranes of the mouth and genitals. A distinctive feature of exudative erythema is subcutaneous compactions of a clearly defined shape, often filled with serous fluid.

If such a papule bursts, bleeding ulcers form in its place. Without any treatment, serious complications can occur, including death.

Migratory

This type of erythema is one of the symptoms of Leyme disease. The disease is characteristic of a tick bite. At the site of the bite, erythema annulare forms - a fast-growing form. In the center of the formation, the skin is paler than at the edges.

Ring-shaped

A chronic disease based on infection, intoxication or an allergic reaction. It got its name due to the fact that numerous red plaques accumulate in conglomerates and form peculiar rings on the skin. This type of disease occurs more often in young men.

Erythema nodosum annularis is a chronic disease.

Clinical picture

The main and main symptom of erythema nodosum is the formation of numerous dense nodules in the deep layers of the dermis and fiber. Seal sizes vary from 5 to 50 mm. The surface of the skin over the formations is smooth, but has a pronounced red tint. Upon palpation, and sometimes visually, it is noticeable how the nodes rise above the surface of the skin. More often, such tubercles do not have clearly defined boundaries as a result of swelling of regional tissues. Erythema nodosum tends to grow quickly, but once it reaches a certain size, the nodes stop growing.

Pain syndrome manifests itself in different ways. Sometimes the pain is felt by touch or palpation, in other cases it occurs spontaneously and in waves, regardless of external influence. Periods of exacerbation of the disease occur in autumn and winter.

After 4-6 days, the resulting red “bumps” begin to behave like a regular hematoma. The skin tone above the node changes to bluish with pink, green and then yellow.

Erythema occurs in the vast majority of cases on the lower extremities, but can also appear on the thighs, buttocks, torso, arms, genital mucosa, neck, face and rarely on the eyeball.

Forms of erythema

Erythema nodosum on the legs has two forms: acute and chronic. The symptoms are different. The acute form is characterized by:

increased body temperature, fever;
chills;
loss of appetite;
general weakness.

Many patients experience arthropathy - inflammation of regional joints. You feel stiffness in the morning, pain when moving or palpating. The joint swells, redness appears, and intra-articular effusion is possible.

The acute form can last from two weeks to a month, depending on the severity of the disease and associated complications. After this period, compactions are permitted. In places where they are localized, hyperpigmented spots or flaky islands of skin remain.

Chronic erythema nodosum is a rarer form of the disease. It is characterized by a wave-like course with periods of remission and relapses. At moments of exacerbation of the disease, single bluish-colored nodes appear. Typically, periods of relapse last up to several months. Chronic disease often occurs in tandem with chronic arthropathy.

Arthropathy often accompanies erythema

Diagnostics

Diagnosis begins with examination of the patient. The patient is required to undergo a set of tests and laboratory tests, with the help of which the disease is differentiated, the causes and associated ailments are clarified. If the patient has an acute form or an exacerbation of chronic erythema, a blood test is performed. The ESR level and the presence of neutrophilic leukocytosis are checked. Bacterial culture of samples from the nasopharynx or feces is carried out to detect streptococcal infection in the body or yersiniosis, respectively. To exclude tuberculosis, the patient is sent for tuberculin diagnostics. If the patient complains of joint pain, an examination is carried out by a rheumatologist.

Sometimes it is not possible to make a diagnosis based on clinical signs. In these cases, a biopsy of the inflamed area is prescribed. According to the doctor's decision, the patient may undergo:

rhinoscopy;
pharyngoscopy;
rheovasography;
X-rays of light;
Doppler ultrasound of the blood vessels of the lower extremities.

Based on the results obtained, treatment is prescribed.

Rheovasography is used to diagnose erythema

Conservative treatments

The success of therapy depends on how correctly the treatment of the disease and accompanying pathological processes was chosen. Effective therapy has three directions of influence simultaneously:

relief of erythema nodosum syndromes;
local treatment of nodes;
eliminating the root cause of the disease.

If a patient is diagnosed with erythema nodosum on the legs, treatment includes taking the latest generation of antibiotics, antihistamines and desensitizing agents. To eliminate inflammatory processes, non-steroidal anti-inflammatory drugs are prescribed. At the discretion of the doctor, the following procedures may be prescribed:

cryopharesis;
extracorporeal hemocorrection;
laser irradiation of blood;
plasmapheresis and others.

Local treatment is aimed at accelerating the processes of disintegration of nodes in the subcutaneous layer. For these purposes, corticosteroid and anti-inflammatory ointments are prescribed, ultraviolet irradiation, magnetic therapy, and phonophoresis are prescribed. Additionally, vitamins of group P, E and C, and preparations with calcium and potassium iodide are prescribed.

In case of severe pain, analgesics are prescribed in the form of injections or in tablet form.

Sometimes erythema nodosum of the extremities manifests itself in women during pregnancy, when it is contraindicated to take most pharmacological drugs and carry out certain procedures. Treatment of pregnant women is carried out under the strict supervision of the treating dermatologist.

With timely treatment and well-chosen therapy, most cases of erythema nodosum of the legs have a positive treatment outcome.

To treat erythema, the doctor will prescribe a set of drugs

Traditional medicine against erythema nodosum

Traditional methods of treating erythema can speed up the healing process when properly combined with drugs and procedures of official medicine. Recipes for ointments, lotions, baths, compresses and herbal preparations are passed down from generation to generation:

However, despite the positive effect of folk recipes, do not prescribe herbal medicine yourself. Please consult your doctor first. Sometimes combining pharmacological drugs with certain herbs gives unexpected results.

Take care of yourself and be healthy!

If you find one or more hot red spots on your lower extremities, under which painful nodes can be felt, then this may be erythema nodosum. It appears on the legs. Which doctor will treat her? What medications and folk remedies can be used for this problem?

What kind of disease is this, how dangerous is it and can you get infected with it?

“Erythema nodosum” is a fairly common diagnosis. What it is? It is an inflammatory disease that affects small vessels located in the dermis and subcutaneous fat. Its main symptom is the formation of red spots and dense painful nodes under the skin.

Anyone can get erythema nodosum, but young women (including pregnant women), older women and children are at increased risk. At the same time, it is especially difficult for young patients to tolerate it.

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It is impossible to say definitively whether this is a dangerous disease. If it occurs as an independent disease, it does not pose a threat to humans. The formations disappear without leaving a trace, are highly treatable and rarely recur. If erythema nodosum on the legs is the result of any serious illness, then the prognosis depends on whether it can be cured. It is impossible to become infected with erythema, but it is quite possible to catch the infection that provoked it.

Why do “nodules” appear?

There are many cases where characteristic red rashes were found after suffering from a sore throat, taking certain antibiotics, sulfa drugs, contraceptives and iodine. Doctors do not deny the influence of the hereditary factor. Chronic infections (tonsillitis, pyelonephritis, sinusitis) and diseases of allergic origin can also cause the development of this disease. Erythema often affects people with diseased blood vessels.

It can also result from:

tuberculosis;
sarcoidosis;
leukemia;
lymphogranulomatosis;
streptococcal infection (scarlet fever, streptoderma);
venous diseases;
fungal infection;
rheumatoid arthritis;
lupus erythematosus;
nonspecific ulcerative colitis;
less often - cancer or leprosy.

Factors contributing to the development of the disease in pregnant women are disturbances in the functioning of the endocrine organs, blood stagnation in the lower extremities, prolonged exposure to cold, seasonal weather changes, and hypertension.

Girls are more susceptible to this disease than boys. Erythema nodosum is most often diagnosed in children over 6 years of age. At the same time, the child becomes very whiny and capricious, complains of pain in the abdomen and joints, red spots of different sizes and very painful nodes form on his legs. The limbs swell, the pain intensifies with movement.

Anti-inflammatory drugs Aspirin, Brufen, Indomethacin are used to treat children. Warming compresses with heparin or ichthyol ointment are placed on the area of the rash.

lubrication of the affected areas with Indovazin ointment, Dip-relief ointment;
the minimum dosage of Paracetamol;
to reduce inflammation - Aspirin (in the smallest doses);
Curantil tablets;
in severe cases - Diclofenac injections;
Antibiotics may also be prescribed (usually macrolides or cephalosporins), but only in the 2nd trimester.

Important! If signs of erythema appear in a child or expectant mother, then making a diagnosis on your own, much less engaging in treatment (even with herbs), is strictly prohibited! This can lead to unpredictable consequences.

The patient should definitely reduce the load on her legs, but, of course, she should not lie in bed all day.

How can traditional medicine help?

You should seek help from a dermatologist or rheumatologist, but you may need to consult an infectious disease specialist, pulmonologist, ENT specialist, vascular surgeon, or phlebologist. To cure erythema nodosum means to find and eliminate the cause that caused it. For this purpose, the following drugs and methods of therapy are used:

if there is a focus of infection, then antibiotics are prescribed - Penicillin, Rifampicin, Tetracycline, Streptomycin. They are prescribed for 1-2 weeks. To enhance the effect, small doses of corticosteroids are used in parallel with them - Prednisolone 15-20 mg once a day after breakfast;
drugs that reduce inflammation - acetylsalicylic acid (0.5-1 g per day), Ibuprofen (dosage individual), Indomethacin (25 mg 2 to 3 times per day);
potassium iodide - 300-900 mg for 2-4 weeks;
vitamins C and P;
plasmapheresis;
in exceptional cases - hormones;
Among the methods of physiotherapy, magnetic and laser therapy, ultraviolet irradiation, and phonophoresis with hydrocortisone have proven themselves to be the best.

The green pharmacy offers its own recipes for eliminating this problem. But they can only be used for primary erythema nodosum:

for oral administration - decoctions of lemon balm, mint, yarrow, red rowan berries, rose hips, hawthorn, elderberry leaves, lingonberries, birch. They should be prepared according to one recipe: 1 tbsp. l. vegetable raw materials, pour 1/2 liter of boiling water, leave for 1-2 hours, drink 1/3 tbsp. before meals;
for topical use - an ointment made from dried and crushed arnica roots (100 g) and the same amount of pork fat. Combine these ingredients and simmer in the oven for 3 hours. Cool. Apply the ointment to the affected area at night under a gauze bandage;
compress of freshly squeezed nettle juice.

Erythema nodosum of the lower extremities is a common dermatological disease characterized by inflammatory lesions of the skin and subcutaneous tissues. It manifests itself in the formation of dense, painful to the touch nodules located symmetrically on both limbs. This pathological condition was first described by the English dermatologist R. Willan in 1798.

Representatives of both sexes suffer from this disease, but women aged 15 to 30 years are affected three times more often than men. It is believed that this is a predominantly female disease, since the disease often manifests itself during pregnancy or when taking hormonal contraceptives. In addition, erythema nodosum can be a sign of many serious diseases. What causes the appearance of pathology, how it manifests itself and what methods are used to treat it, you will learn from this article.

For many years, erythema nodosum was considered a specific nosological entity in dermatology. But recent studies have shown that in fact, skin pathology is one of the manifestations of allergic vasculitis. In every third patient, erythema develops as an independent disease and is classified as primary. In all other cases, the disease occurs against the background of concomitant pathologies and is defined as a secondary form.

What causes cause sensitization of the body and lead to the appearance of characteristic symptoms? First of all, there are many infectious and non-infectious factors. Genetic predisposition also plays a certain role in the development of the inflammatory process.

Infectious causes include the following concomitant diseases:

streptococcal infections;
tuberculosis;
chlamydia;
histoplasmosis;
cat scratch disease;
yersiniosis;
psittacosis;
cytomegalovirus infection;
Epstein-Barr virus;
Hepatitis B;
sexually transmitted diseases (syphilis, gonorrhea, etc.);
tychophytosis;
inguinal lymphogranulomatosis.

Among non-infectious factors, the following conditions are noted:

In addition, erythema nodosum can be caused by vaccination or taking certain medications (salicylates, sulfonamides, antibiotics, hormonal contraceptives, iodides). Experts note that patients with allergic diseases (hay fever, bronchial asthma), vascular disorders (atherosclerosis, varicose veins), or with foci of infection in the body (pyelonephritis, tonsillitis, etc.) are predisposed to the development of erythema nodosum.

Erythema nodosum of the lower extremities is defined as a nonspecific immunoinflammatory syndrome. To date, the mechanisms of its development have not been fully studied. Scientists suggest that provocateurs are various infectious agents and certain chemicals contained in medications.

They create a certain antigenic background, to which a healthy body does not react in any way, but if there is a genetic predisposition, it gives an immune response and triggers a series of biochemical reactions aimed at producing antibodies. Since pathology often manifests itself during pregnancy, this is associated with changes in hormonal levels and malfunctions of the immune system, as a result of which the woman’s body cannot resist the influence of negative factors.

In the international classification of diseases, pathology is assigned the code “erythema nodosum ICD 10- - L 52”. The development of erythema nodosum begins with damage to the small blood vessels of the lower extremities. At the same time, the adipose tissue located at the border of the dermis and subcutaneous fatty tissue also undergoes changes.

In the first two days from the onset of the development of the pathological process, inflammation covers the walls of the veins (less often arteries). The cells of the vascular wall swell, and compactions (infiltrates) appear in them, consisting of eosinophils and lymphocytes. Hemorrhages are observed in the surrounding tissues.

About a week after the appearance of the first unfavorable signs, characteristic changes in the composition of the cellular infiltrate begin to develop. Vascular obstruction develops, lymphocytes, plasma cells and giant cells appear in the fatty lobules, and the likelihood of microabscess formation increases. Subsequently, infiltrates in the vascular walls and fatty lobules are converted into connective tissue. In this case, the epidermis and upper layer of the dermis are usually not involved in the pathological process.

The main characteristic symptom of the disease is the appearance of dense nodules with a diameter of 1 to 5 cm in the lower tissues of the dermis and subcutaneous fat. The nodules rise slightly above the skin, have clear outlines, the surrounding tissues swell, and the skin above the lump becomes red and smooth. After a few days (from 3 to 5), the nodes become denser, the skin over them acquires a bluish tint and gradually turns yellow, as with a hematoma. Visually, such manifestations resemble a bruise.

Inflamed lumps are usually localized on the front or side of the lower leg and are located symmetrically on both legs. In addition, elements of erythema appear in the subcutaneous fat layer on the calves, thighs, buttocks, forearms or face. The nodules grow quickly to a certain limit, while there is no itching, but the patient feels pain, which intensifies when the lump is palpated.

The disease usually begins suddenly and is accompanied by a general deterioration in health. The patient complains of weakness, lack of appetite, fever, chills. Sometimes joint pain, morning stiffness, and symmetrical inflammation of the joints appear. There is swelling in the small joints of the hands and feet, which makes diagnosis difficult, since such manifestations are perceived as symptoms of arthritis.

After 2-3 weeks, the nodes disappear, and along with them the joint and skin manifestations of the disease go away. But in some cases the disease takes a chronic course and periodically returns with relapses. During exacerbations, dense single nodes appear with a bluish tint, painful on palpation. The chronic form of erythema nodosum can haunt the patient for several months.

Erythema nodosum is more often diagnosed in girls and appears during the cold season or in the off-season. The development of the disease is facilitated by the presence in the body of a viral pathogen or infectious agents such as staphylococcus, streptococcus, and candida. The disease begins acutely; children develop painful, hot to the touch nodes on the front surface of the lower leg, thighs or forearms.

There is a general malaise, the child is capricious, refuses to eat, his temperature rises, chills and headaches occur. The nodes are dense, hemispherical in shape, rising above the surface of the skin, the skin around them is inflamed and swollen.

A distinctive feature of such nodes is a gradual change in color. At first they turn from red to bluish, then their shade gradually turns yellowish-green. At this stage, the nodes resolve and become flat. At the same time, the peculiar coloring of the nodes resembles bruises left from bruises.

This is clearly visible in the photo of erythema of the lower extremities. In children, the disease is often accompanied by damage to the joints, with characteristic manifestations: pain, swelling, redness of the skin. After a few days, the inflammatory process subsides, but pain in the joints persists for some time.

The duration of the disease is usually 3-4 weeks. As the nodules disappear, the skin may be left with flaking and pigmentation, which will subside over time. In case of repeated relapses of the disease, a thorough examination of the child is necessary. Timely treatment will allow you to avoid possible complications and the transition of the disease to the chronic stage.

Depending on the characteristics of the clinical picture and the severity of symptoms, experts distinguish the following types of erythema:

An experienced dermatologist can easily make the correct diagnosis based on a general examination and clinical symptoms. To clarify the diagnosis, a number of laboratory tests are prescribed:

general blood analysis;
bacteriological culture;
biopsy of the nodule;
histological examination.

If necessary, the patient is referred for Doppler ultrasound of the vessels of the lower extremities, computed tomography or rheovasography. To determine possible provoking factors and identify concomitant foci of infection in the body, the patient is referred for consultation to other specialists: phlebologist, vascular surgeon, pulmonologist, infectious disease specialist, otolaryngologist, rheumatologist.

Based on the diagnostic results, the doctor individually selects a treatment regimen. It should be aimed not only at suppressing the symptoms of the inflammatory process, but also at eliminating the provoking factors that cause the development of pathology. Complex therapy for erythema nodosum includes the following measures:

The use of antibacterial therapy aimed at suppressing the source of inflammation;
The use of external preparations (ointments, creams) with anti-inflammatory and regenerative effects;
Treatment with NSAIDs (non-steroidal anti-inflammatory drugs);
Taking antihistamines and desensitizing agents;
Physiotherapeutic procedures.

Patients are advised to remain in bed. Chronic foci of infection in the body are suppressed with the help of antibacterial drugs (penicillin, erythromycin, doxycycline), antifungal and antiviral agents. Anti-inflammatory drugs (Diclofenac, Ibuprofen, Indomethacin), salicylates (Askofen, Aspirin) are prescribed. The treatment regimen must include antihistamines that suppress the nonspecific reaction of the immune system (Tavegil, Claritin, Suprastin, Zyrtec).

If there are no infectious diseases, corticosteroids (Prednisolone, Methylprednisolone) are used to quickly eliminate the inflammatory process. For recurrent and chronic forms of the disease, the use of aminoquinoline drugs (Plaquenil, Delagil) is indicated.

Local treatment is based on the use of external agents with an anti-inflammatory effect: hormonal ointments (Sinaflan, Akriderm), compresses with Dimexide. The use of extracorporeal methods helps to quickly eliminate painful symptoms: laser irradiation of blood, plasmapheresis, hemosorption. To restore blood vessels, drugs are used - angioprotectors (Trental, Delagin, Aescusan).

Physiotherapeutic procedures have a good effect. The following methods are used to treat erythema nodosum:

Phonophoresis with hydrocortisone;
Laser irradiation;
Magnetotherapy;
Diathermy;
Compresses with Dibulon or Ichthyol solution.

At the final stage of therapy, the patient is prescribed immunomodulatory drugs and vitamin-mineral complexes.

After treatment, the patient is advised to avoid high physical activity for a month. In order to prevent further relapses, you should adhere to a hypoallergenic diet.

It is necessary to avoid eating foods that can cause an allergic reaction, give up fried, smoked, salty, spicy foods and give preference to a dairy-vegetable diet. It is necessary to promptly treat foci of infection in the body, lead an active lifestyle, maintain immunity and increase the body's defenses.

Previously, it was believed that the appearance of symptoms of erythema nodosum during pregnancy poses a threat to the full development of the fetus. To exclude the birth of a child with congenital developmental anomalies, women were offered artificial termination of pregnancy.

Currently, the extensive capabilities of modern diagnostic methods make it possible to reliably establish the type of infectious agent that provokes the inflammatory process. This makes it possible to understand which factors do not have any effect on the development of the embryo.

In acute forms of erythema nodosum, the main burden falls on the female body; the woman's cardiovascular system experiences a toxic effect, while this inflammatory process does not affect the development of the child. In some cases, erythema nodosum may even go away on its own by the end of the 2nd or 3rd semester.

Since it is undesirable to use drug treatment during pregnancy, specialists limit themselves to prescribing external agents with anti-inflammatory and analgesic effects. During exacerbations of the disease, the woman is recommended to have bed rest and limit any psycho-emotional disturbances. In addition, the doctor can recommend the optimal combination of physical activity and rest. In the future, after delivery, such treatment tactics will help to avoid the transition of the disease into a sluggish chronic form.

In itself, a disease such as erythema nodosum of the lower extremities is not dangerous, but it is most often a companion to many severe pathologies. Therefore, timely consultation with a doctor and undergoing an examination help to identify and eliminate concomitant diseases and thereby prevent possible complications. If alarming symptoms appear, you should consult a rheumatologist or dermatologist. When treatment is prescribed in the early stages of the disease, the prognosis is usually favorable.