The nodular lesions of the skin

1. Gastroepato
2. Dermatology
3. The nodular lesions of the skin
4. Lesions in dermatology
5. The red patient
6. Erythema
7. Skin lesions

erythema nodosum, nodular vasculitis, panarteritis, fungal gums and suspected lesions

Before talking about rare lesions, of nodular appearance, that is, like those you have found on the neck, hard and painful as peanuts, or the armpit, I want to reassure our surfers by telling them that most of the nodular lesions they suffer from can almost always be traceable to a lipoma, ie a roundish, not painful, soft or harder relief, of elastic consistency, displaceable on the tissues, of the size of a few mm or more cm, referable to a collection of fat covered with a fibrous capsule, sometimes multiple.

At other times you are palpating simple inflamed lymph nodes, e.g. for an otitis or a dental abscess.
If these injuries are disrupted, they can be excised surgically. Sometimes the nodular lesion may be a lymphadenopathy, or a trivial infection of the sweat glands of the axilla, if you sprayed those odor sprays! For the rest here we will talk about lesions of the nodular aspect of the skin, that is of processes in circumscribed durations protruding from the dermis, sometimes of woody consistency, other times soft, others still taut-elastic, movable or not on the cutaneous planes. The non-displacement of the lesion may indicate malignancy, so watch out for skin lesions. Always consult your doctor and request, if appropriate, a skin biopsy to ascertain its nature.

Erythema nodosum

It is a morbid form that affects the skin, frequently observed in children and adults, especially in females. It manifests itself with the appearance of a series of skin lesions, mainly located in the legs and arms and on the buttocks. The lesions are detected, of bright red color, with a dermo-hypodermic seat, warm to the touch, roundish, of volume ranging from a pea to a nut, with a modest edema of the affected limb. They can heal without leaving relics in about 2-3 weeks.

During their evolution towards healing, some nodular lesions pass from a red color, towards those of the trivial ecchymoses, that is from the blue to the yellow green, hence the definition of "contorted forms dermatitis". The lesions, again, can be associated with febrile episodes, with asthenia and arthralgia, usually related to bacterial sepsis. At microscopy, if lesions are histologically studied, infiltrations of neutrophils and less fibrocytes are observed, eosinophilic lymphocytes and mast cells at the border between the dermis and hypodermis. In the small blood vessels, a series of cellular sleeve infiltrates and congestive events are highlighted. Nodular erythema is considered to be the body's response to stimuli of various kinds to which the body has hypersensitized.

It can generally be a sign of dangerous bacterial infections from streptococcus, tuberculosis and sarcoidosis. Therefore, it is good practice to carry out a series of laboratory investigations ranging from simple research of the antistreptococcal title or TAS, to inflammation indexes such as PCR, to the RX scan of the thorax to exclude the presence of suspicious nodes and nodules of tubercular nature or old tuberculin intradermoreation. Sarcoidosis, a multi-systemic disease, very insidious and of severe prognosis, which is characterized by non-caseous granulomas, ie infiltrates of inflammatory cells in the tissues, with involvement of the respiratory system, liver and spleen, must be excluded, which is not very simple. and lymph nodes.

Nodular vasculitis

Other similar manifestations always at a dermo-hypodermic site, are the nodular vasculites, ie the migrating nodular hypodermite, patches similar to the erythema nodosum but which resolve at the center and leave a halo around, always present in the limbs but also in the trunk, free on the deep, indolent plans.

A similar expression is that of the Bazin-induced erythema, due to tuberculosis. Also in this area of lesions are nodular vasculitis, not preceded by tubercular facts, in the form of knots, from a pea to a nut, hard and pasty, sometimes cyanotic, always in the legs, anterior-external and posterior surpluses , which soften and may even ulcerate at the center I can be associated with pyogenic infections. On the side you can see the photo of a patient suffering from Recklinghausen's disease or neurofibromatosis, that is a neuro-ectodermal dysplasia with cutaneous symptomatology.

Panarteritis nodosa

Periarteritis or panarteritis nodosa, an infrequent morbid form, is characterized by lesions at the arterial level, as an expression of a systemic form and of a cutaneous form only. In the systemic form, very serious, we reach the exitus within months or years, with fever and weight loss, and visceral impairment, being affected urinary, cardiovascular (infarct, aneurysm), digestive (ulcers, the nervous system, the eye.The skin manifestations are clinically varied but determined by Arterial alterations: typical lesions, such as nodes of 1/2 or 2 cm of diameter, acro localized and placed along the blood vessels, detected, painful, hard, red-alive, infiltrated. to occlusion and hemorrhages that can evolve towards ulcerations.Other characteristic is the presence of the "livedo", that is a cutaneous or reticular skin coloring of the vascular pattern, especially to the sloping regions, with hemorrhagic, dermal-epidermal punctuations. the vessels appearing littered with inflammatory infiltrates, foci disseminated with fibrinoid necrosis at the level of the intima and the average. of strange antibody movements and elevations of inflammatory indices.

Mycotic gums

Another lesion of the nodule type is the micosic gum, that is the sporotrichosis due to a particular micete, hardly found in our areas, the Sporotrichum schencki, mycorrhita micete in the environment that surrounds us that penetrates into cutaneous solutions of arms and forearms and gives origin to a nodular lesion of the papulo-nodular type that then spreads lymphatically and evolves as gum, that is, as infiltrate that ulcerates. If the fungi penetrate the skin they can cause much more serious lesions with tissue deformation, because they penetrate even in the muscles.

Actinomycosis

They are rare forms due to Israeli actinomices, particular types of saprophytic bacteria that are located in cervico-facial lesions, cheek and neck. Here too the lesions are nodular, as hypodermic plaque, hard, extended, erythemato-cyanotic, with leakage of purulent material (cf. for differential diagnosis the tines and the hairy mycosis). The pus is characterized by granules of yellow-sulfur color, very peculiar of the lesions. Histologically, infiltrates with pseudomycellar filaments, such as tangles of filaments, are evident.