erythema nodosum differential

erythema nodosum differential

Pathological causes of complex disease etiology, is generally believed that infections, particularly streptococcal infection and drug response.
Erythema nodosum addition, tuberculosis is an important predisposing factor, especially in children. Viruses, fungi and other infections, bromides, iodides, sulfonamides and other medications can trigger the disease. 1, Streptococcus infection: may occur in some patients with upper respiratory tract infection, angina, and acute tonsillitis after. 2, Mycobacterium tuberculosis infection: the disease since 1872 Uffelmana made after infection with M. tuberculosis, and gradually by the people''s attention, more and more evidence that the disease is closely related to TB infection. National statistics concomitant TB infection, or had old tuberculosis, or Results element test positive, accounting for more than 60%, that is the body of the TB disease or toxin allergy. 3, for other reasons: some of the drugs, in particular bromine agents and sulfa drug, is the most common cause of the disease. Others such as coccidioidomycosis, histoplasmosis, cat scratch fever, Trichophyton disease, ulcerative colitis, sarcoidosis, Behcet''s disease, leprosy and venereal lymphogranuloma, may be associated with tuberous erythema. In addition, the virus infection associated with the disease, other rare causes such as acute genital ulcers, acute and chronic leukemia, may also be associated with the disease. Pathogenesis 1, the disease is caused by a skin a

llergy for many reasons, the real pathogenesis is unclear. Some people think that is a kind of allergic vasculitis, but the use of immunofluorescence technique has failed in necrosis or allergic vasculitis were found to have immune complex deposition. Also suggested that vascular disease is a microbial or other antigens on the delayed type hypersensitivity. 2, the major pathological changes occur in the subcutaneous fat layer and the subcutaneous fat lobules interval. In the early phase of acute inflammation, mainly neutrophil infiltration, accompanied by a small amount of lymphocytes, eosinophils, and a small amount of red blood cell extravasation. With the progression of the disease, neutrophils quickly disappeared, replaced by lymphocytes, plasma cells and tissue cell infiltration. Interval in the fat lobules, there may be giant cells accompanied with fibrin exudation. Vessel wall thickening, endothelial cell proliferation and luminal occlusion, no abscess and caseous necrosis, normal skin. 1 Symptoms of erythema nodosum is a common vasculitis caused by the nodular skin diseases,
Erythema nodosum is common in the lower leg extended side of red or purple painful inflammatory nodules, more common in young women, there are limitations of course, easy to relapse. History prior to the onset of infection or medication history, skin lesions suddenly, for the bilateral symmetry of the subcutaneous nodules, ranging from beans to a large walnut, the number of 10 or more, conscious pain or tenderness, moderate hardness. Early skin color pink, smooth, slightly elevated, a few days later, the skin color turn dark red or green and red, the surface flat. 3 to 4 weeks after the nodules gradually subsided, leaving a temporary pigmentation, ulceration never nodules. Lesions occur in the tibialis anterior, but also found in the thigh, upper arm and neck extensor side, rare on the face. Chronic erythema nodosum is different from the characteristics of acute erythema nodosum, which often occurs in older women, skin lesions were unilateral, if bilateral, is asymmetric, in addition to joint pain, but not associated with other systemic symptoms. Nodules are not painful, and soft than acute erythema nodosum. 2 Check the blood test white blood cell count usually normal or mildly elevated, but in the beginning, accompanied by high fever, tonsillitis or pharyngitis, the white blood cell count and neutrophil count significantly increased. Rheumatoid factor can also be positive. Determination of serum was elevated P2-microglobulin. 1, blood and erythrocyte sedimentation rate, usually without anemia, and sometimes leukocytosis, 2 / 3 of the patients increased ESR. 2 immunological tests, when in accompanied by tuberculosis, tuberculin test can be positive. X-ray examination when the primary disease is tuberculosis, often can be found in the hilar lymph nodes. Reported in 16 to 30 year-old young women, who have erythema nodosum, X ray showed bilateral pulmonary portal lymph nodes are known as Buner syndrome, and that such patients with hilar lymph nodes, in fact, Systemic erythema nodosum of a performance. 3 Identification of erythema nodosum confused easily with the following diseases: Hard red spot occurred in the leg flexor side, often a single or number of lesions compared with erythema nodosum for large, longer duration, can spontaneously rupture, the formation of ulcers , different degrees of atrophy left after healing. Return febrile nodular nonsuppurative panniculitis nodular regression febrile non-suppurative panniculitis is erythema nodosum skin lesions, mainly located in the chest, abdomen, stock, buttocks, into the group appeared after the disappearance of left atrophy and depression of local dish, each episode had fever, pathological changes of fat tissue inflammation. Subacute nodular migratory panniculitis subacute nodular migratory panniculitis in leg erythema nodosum-like rash, usually early course of the disease can occur in unilateral, painless, was eccentric expansion edge of the red, the central white, can be gradually flattened to form plaque, size 10 ~ 20cm, the duration of two months to two years, the performance of pigmentation, also known as migratory erythema nodosum. Nodular vasculitis disease occurs in middle-aged women. Nodules in the lateral and posterior lower leg, after a slow and sometimes ulceration were. 4 complications of the disease in certain diseases can also be used as a concomitant symptoms, such as meat-like tumor, leprosy, ulcerative colitis, the limitations of enteritis, lymphoma, leukemia, Behcet disease, connective tissue disease. The pathogenesis of EN is not entirely clear, it was thought to be the body of a certain pathogenic microorganisms antigen delayed-type hypersensitivity; also suggested that an immune complex disease. 5 treatment of systemic therapy (1) search for a cause, be treated accordingly. Acute phase may be bed rest, Taigaohuanzhi, avoid exposure to cold and strong labor. Obvious infection focus, could with antibiotics. (2) pain than the , can be oral analgesics, and non-hormonal anti-inflammatory drugs, such as indomethacin (indomethacin) per 25mg, 3 times a day; ibuprofen every 200mg, 3 times a day. Significant infection, to the antibiotics. In severe cases, a corticosteroid such as prednisone (strong pine) 30 ~ 40mg / d, or betamethasone / betamethasone dipropionate (Depot Song) lml IM, 3 weeks, 1, can be quickly control the disease. In addition, 10% potassium iodide mixture 10ml, 3 times a day, serving 2 to 4 weeks. The method is safe and effective, but should pay attention to long-term use can lead to hypothyroidism. Refractory disease, could apply hydroxyl quinoline nitrogen 200mg, 2 times a day; dapsone (DDS) 50mg 2 times a day, but also Chinese herb Tripterygium Aboriginal tablets tablets or Kunming. UV can also be used systemic treatment, wax treatment, diathermy or audio electrotherapy. Local anti-inflammatory treatment of the principle of local treatment and pain relief. B topical ointment fish,
Erythema nodosum camphor ointment 10% or 75% alcohol bandage wrap local wet packing, the other treated with corticosteroid ointment, analgesic effect. Lesions can also be injected triamcinolone suspension of about 0.3ml plus 2% procaine solution injection, severe pain on the nodules continued to have significant effect. Painful swelling of TCM are cream with hibiscus, dark red skin lesions, burning, swelling was not obvious who used purple paste. Chinese Medicine (1) wind-heat type wet card: Main symptoms: a large red spot high apricot, the color red pain, aversion to cold with fever, headache and limb pain, pink tongue, thin white fur a little greasy, floating pulse or Fu Hua. Governing Law: Shufeng cooling, dehumidifying meridians. (2) damp card: Main symptoms: nodules as large as red dates, around the shin and hair, when there is pain, accompanied by Shenpi fatigue, drowsiness addicted to lying, heavy joint pain, lower extremity edema, red tongue, thick and greasy fur , slippery pulse number. Governing law: heat and dampness, promoting blood circulation network. (3) Blood Heat intrinsic Card: Main symptoms: the color red nodules, burning pain accompanied by fever, thirst, irritability, joint pain, dry stool, urine short of yellow, red tongue, little coating, pulse a few strings. Governing law: heat and cooling blood, circulation meridians. (4) alpine resistance network card: Main symptoms: light red or dark purple nodules, Yuhan worse. Often recurrent, with pale face, cold limbs, pale tongue, thin weak pulse. 6 Care Eye Care eye with a clean cotton swab dipped in saline solution, pay attention to clear secretions, crusts fall off and lashes, and then rifampicin, asked a hundred persons or ganciclovir eye drops are used interchangeably, 2 3 times / d, both done in collaboration. Most children with oral care and oral mucosal erosions lips appear to encourage more children with their own 5% sodium bicarbonate mouthwash, mouth rinse if necessary, with the benefit 2 to 3 times / d; available for smaller children with sodium bicarbonate 2.5% or the benefits of oral mouth wash to prevent thrush occurring; perioral skin dryness clear coated cod liver oil protect the children. Most children recover in 5 ~ 7d. Children with urinary tract care to encourage more water, urinating frequently the natural flushing the urethra and prevent urinary tract infections. Urination impaired by heat on, listening to the sound of water or soft reduction then the solution to help the bladder area. Children by applying the above solution can not be, prescribed catheterization, and urine routine examination on a regular basis the line, the daily use of antibiotics solution bladder irrigation, catheterization is not set more than 1 week. Care given to children with high-calorie diet, nutritious and easily digestible liquid or semi-liquid diet, spicy food so as not to stimulate the fast mouth sores; disable the fish, shrimp, milk and other food allergies, to prevent further induced by allergic rash. Difficulties of those who prescribed intravenous feeding supplement to ensure adequate nutrition and calories, and promote skin repair. 7, six points of erythema nodosum syndrome 1. Qingrejiedu: Chinese medicine, heat can be raw drugs, erythema nodosum is a toxin produced by vein disease. Cause capillary bleeding, clear blood per heat, toxins from the consumer. Disease can be cured. 2. Blood circulation: medicine believes that all diseases to stasis based. Blood circulation, Shu by meridians. Blood stasis can not live lag, the nodular blood running red spot just fine. 3. Heat dehumidification: Chinese medicine, energy raw wet, wet to raw drug. Clear the body of the heat, the body of the drug solution can be completely cured of erythema nodosum disease. 4. Endometriosis: erythema nodosum diseases that can cause skin and muscle tissue lump on the mucosal swelling and other diseases, traditional Chinese medicine treating the symptoms of oral topical Endometriosis, disease disappear naturally. 5. Comfortable and easy: medicine, raw wind evil, evil can be sick. Naturally disease with erythema nodosum, and the wind scattered to the cold, disease can be self-extinction. 6. Dehumidification phlegm: Chinese medicine, wet to phlegm, sputum can be raw evil, evil to illness, erythema nodosum disease is a sputum evil generation. Dehumidification phlegm disease can heal. 8