Implanted nodules

Introduction The nodule lesion is more rash, the papule damage is large and deep, and it penetrates deep into the deep dermis, and the heavy one can reach the subcutaneous tissue. The surface is semi-circular and smoother. The surface of the inflammatory nodules is red, painful and angular pain, and the diameter is 0.5~5cm. In the late stage, there are often ruptures, such as late syphilis nodular lesions, and skin tuberculous nodules are debilitating. The histopathological changes of the nodules are deeper in the deep dermis and can invade the subcutaneous fat layer, so it can be associated with changes in lipid membranes and blood vessels. The pathological changes of the superficial dermis were mild, and the pathological changes of the rash and papules were different in the epidermis and dermis. According to the different causes, the nodules can be limited, the disease is asymmetrical, and the number is small; it can also be systemic, symmetric, and the number is small or sparse. Nodular dermatosis generally has mild systemic symptoms, slow onset, and relatively long course of disease, such as skin tuberculosis, syphilis, and chronic erythema. Therefore, it is clinically different from rash and papular skin diseases. The nodules are divided into inflammatory and non-inflammatory.

Cause

First, non-inflammatory nodules

(a) rheumatoid nodules

Autoimmune disease

(B) late syphilis near joint nodules

It is a rigid and fibrotic nodule with no red tumor.

(3) Skin porcine cysticercosis nodules

People ingested aphid eggs through the stomach and ten fat intestines hatched out six hooks, cattle into the intestinal wall through the blood, lymph into the skin to form a large peanut, round nodules.

(four) gout nodules

Gout is a metabolic disorder. Serum uric acid is elevated, and uric acid is deposited in the form of crystals in the form of gout stones. Occurs in the toe joints.

(5) Nodular xanthoma

For lipid metabolism disorders, caused by high p-lipoproteinemia. The dermis has diffuse foam cell infiltration.

(6) Nodular calcinosis

More common in children with dermatomyositis, mostly in the joints of bone and joint disease.

(7) Pneumocystis nodules

There are often infections with paragonimiasis.

(eight) ear wheel chronic nodular chondruff dermatitis

More caused by traumatic frostbite.

(9) Skin fever

It occurs in the case of Leishmania small body invading the skin membrane. It can be secondary or secondary to visceral infection.

Second, inflammatory nodules

(a) microorganisms

Bacteria

(1) Tumor-type leprosy: The pathogen is Mycobacterium leprae, positive for acid-fast staining, and positive for Gram stain. The tumor type and the boundary type leprosy nasal film have the highest rate of bacteria. 200 million pieces of bacteria are sterilized every day. Therefore, the respiratory tract is the main route of infection.

(2) skin tuberculosis: the pathogen is Mycobacterium tuberculosis, acid-fast staining, skin tuberculosis is reinfection, and common is lupus vulgaris. It is often invaded by the skin trauma.

(3) Hard erythema: often caused by tuberculosis or lymph node tuberculosis, is a tuberculosis type.

(4) Tuberculous nodular phlebitis: often invade the lower leg, the foot, and the erythema nodules consistent with the vein, forming a strip.

(5) Nasal induration: caused by infection with Klebsiella pneumoniae. Caused by Gram-negative Brevibacterium, initially rhinitis, followed by nasopharynx, soft palate, and nose to form a tough, purplish red nodule.

(6) Swimming pool granuloma: infected by swimming pool mycobacteria, mostly due to bruises and infections, prone to elbows, knees, hands and feet and lower legs, producing brown nodules or plaques.

(7) Mycobacterial ulcer: The pathogen is ulcerative mycobacteria, which is a saprophytic bacteria in tropical soil, which occurs in the calf and forearm and is a painless solid nodule that can be ulcerated and crusted.

(8) Late nodular skin syphilis rash: the lesion consists of a ring-shaped nodule, often ruptured.

(9) Late skin syphilis rubber swelling: occurs in the joint surface susceptible to trauma and soft palate, the size of the finger is large to large walnut, hard and tough, asymptomatic, but easy to ulcerate to form a kidney shape and horseshoe shape. (10) Facial miliary lupus: In the past, it was considered to be tuberculosis. Although there were tuberculosis changes in histology, tuberculin was negative and no tuberculosis was present. It is currently considered to be unrelated to tuberculosis.

(11) Inguinal granuloma: The pathogen is granulomatous Klebsiella-negative Brevibacterium, which is oval in the mononuclear cells, namely Donovan bodies. More in the perineum, genitals, perianal hard nodules, rupture edge bulge is papillary-like hyperplasia. Attribute-borne disease.

(12) Acute febrile neutrophilic disease: The cause may be vasculitis caused by a bacterial or fungal antigen and a corresponding antibody forming a rabbit plague complex.

(13) nodular erythema: mostly caused by streptococcus, tuberculosis infection, also seen in leprosy out of BehCet disease and drugs.

2. Viral

(1) Milking pox: caused by the burdock virus, which occurs mostly in the fingers of the milking or slaughtering workers and the forearm injuries.

(2) Nodular polyarteritis: a rabbit with a compound small arteritis, associated with hepatitis B virus, with high Y globulinemia, mostly in middle-aged men.

3. Fungal, such as pool filariasis, caused by S. sinensis. It is divided into fixed type and lymphatic type, and it is a string of purple-red painless nodules along the lymphatic vessels.

4. Parasitic acne nodules, which are transmitted by human sputum, and the toxins in the stratum corneum of the skin cause severe itching. In the male scrotum, the penis forms a red nodule itchy.

(2) Physical factors

1. Cold panniculitis occurs in infants and young children, with poor peripheral blood circulation, and cold factors, which are caused by subcutaneous fat damage.

2. Traumatic fat necrosis is caused by trauma, common in women, may be caused by vascular injury

3. Neonatal subcutaneous fat necrosis may be caused by trauma and cold at birth. More than 1 to 6 weeks after birth.

4. Light linear granuloma is a chronic granuloma caused by exposure to sunlight.

5. Foreign body buds swollen various foreign bodies such as paraffin, quartz. Metal quilts, lead, etc., and silk and nylon threads can cause foreign body reactions and granuloma.

(three) immune allergic

1. Allergic skin vasculitis is an allergic reaction caused by bacteria, viruses, proteins, drugs. Leukocyte-fragmented vasculitis caused by immune complexes is a dish-type allergic reaction.

2. Facial eosinophilic buds have single or multiple red nodules on the face, which is an allergic vasculitis immune complex deposition.

3. Allergic to granuloma is granuloma-forming necrotizing vasculitis. It is characterized by increased asthma and eosinophils, up to 0.20~0.30.

4. Giant cell arteritis This disease is granulomatous arteritis, which invades the branches of the aorta. Many of the symptoms are caused by vascular occlusion, which is red painful nodules.

5. Nodular pruritus is caused by mosquito bites in many patients, and the two legs are stretched to the side. The red papules are itch at first, and the thickening and keratinization are nodules after grasping.

6. Deep lupus erythematosus is also known as lupus fat paste. Skin lesions are characterized by deep subcutaneous nodules or plaques that are tough and can be applied to any area. The vascular wall of the fat layer has immunoglobulin deposition.

(4) Other or unexplained reasons

1. Nodular vasculitis occurs in women 30-50 years old, with larger nodules, located on the back side of the calf, without rupture. Regress

After the hard fibrotic nodules.

2. The cause of sarcoidosis is unknown, and it can be manifested in various forms, such as small nodule type and large nodule type. However, its pathological features are epithelioid cell granuloma, which is common in giant cells.

3. The cause of nodular febrile non-suppurative panniculitis is unknown. It is common in young and middle-aged women and occurs in the thighs and buttocks. It is a painful nodule and plaque, about 1-10 cm in diameter.

4 proliferative nodular pityria can cause proliferative brown-purple nodules due to the mixture and iodine, and naturally disappear after stopping the drug.

5. Corticosteroids after the long-term use of corticosteroids, the drug is suspended for 1-30 days, more common in children. The lesion was red solid subcutaneous nodules.

6. The cause of subacute nodular migratory panniculitis is unknown. Of the 11 cases reported by Perry in 1964, 9 had a history of tonsillitis before onset.

7. The cause of subcutaneous nodular granuloma is unknown. More common in children. Occurs in the lower limbs or arms and is a purple red nodule.

8. Nodular arterial inflammation is an immune phenomenon, which may have high Y globulinemia, rheumatoid factor positive, may have hypocomplementemia, the pathogenesis is immune complexes, and recently found B. This type of viral hepatitis can occur. The skin lesions are mostly in the calf.

an examination

Related inspection

Rheumatoid factor (RF) blood routine urine routine

Extractable nuclear antigen (ENA):

The extractable nuclear antigens are mainly anti-ribonucleoprotein (RNP) antibodies and anti-Sm antibodies.

Rheumatoid factor (RF):

Rheumatoid factor is an autoantibody against human denatured immunoglobulin that appears in the serum of patients with rheumatoid arthritis and other diseases.

Serous effusion cell count:

The cell count is the number of cells in the effusion. Microscopic counting and specimen dilution methods are generally used. The direct counting method is suitable for clear appearance and number of cells.

Calcitonin (CT):

Calcitonin is a peptide hormone synthesized and secreted by thyroxine follicular cells, which can reduce the concentration of calcium and phosphorus in plasma and inhibit the absorption of calcium and phosphorus.

Lupus cells:

Mainly used for the examination of systemic lupus erythematosus.

Procaine intradermal test:

Intradermal testing is required prior to injection of procaine to prevent allergic reactions during injection.

Penicillin intradermal test:

An allergic reaction is required before the injection of an allergic reaction to prevent an allergic reaction at the time of injection.

Streptomycin intradermal test:

An intradermal test is required prior to injection of streptomycin to prevent an allergic reaction at the time of injection.

Antiglobulin test (Coombs test):

The antiglobulin test, also known as the Coombs test. Refers to a method of detecting incomplete antibodies in the blood.

Anti-mitochondrial antibodies (AMA):

Refers to an antibody against the mitochondrial inner membrane lipoprotein component, without organ and species specificity.

Uric acid salt:

Urine check. Determination of urinary oxalate has a certain diagnostic value for primary hyperoxalic acidemia.

Differential diagnosis

Multiple nodules: Multiple nodules of the thyroid are a type of thyroid nodules. Thyroid nodules are a very common condition, especially in middle-aged women. Thyroid nodules are divided into two categories: benign and malignant. Benign nodules account for the majority, and malignant nodules are less than 1%. There are many thyroid diseases in the clinic, such as thyroid degeneration, inflammation, autoimmunity and new organisms, which can be expressed as nodules. Thyroid nodules can be single or multiple, and multiple nodules have a higher incidence than single nodules, but the incidence of single nodular thyroid cancer is higher.

Single solid nodules: necrosis occurs at the center of the granulomas, but not calcified. When the lesion spreads around, the bronchial and mediastinal lymph nodes can be swollen, purulent, and even cause pleurisy. Skin-type germination is characterized by a single or multiple skin granuloma, and finally liquefaction necrosis and ulceration occur in the center. The pathogen of cryptococcosis is Cryptococcus neoformans, which mainly invades the brain, meninges, paranasal sinuses, lungs, spleen, muscles, joints, skin, etc., causing movement disorders, circling movements, abnormal behavior, lameness, and rhinorrhea. At the time of necropsy, there were small suppurative lesions in the paranasal sinus, nasal turbinates, nasal cavity and brain, and there was mucous purulent inflammation in the meninges. Subcutaneous granuloma can be seen in the ear, eyelids and feet.

Fibrous calcified nodules: Symptoms of calcification of the body's fibrotic nodules occur mostly in the lungs. Imaging studies can be diagnosed.

Pseudotuberculous nodules: 10 days after the acute egg nodules, the trichomes die, the eggs and necrotic substances are cleared, absorbed or calcified, and the macrophages in the lesions are transformed into epithelioid cells and foreign bodies multinucleated giant cells, forming and nodules. Nodular granuloma, called pseudotuberculous nodules.

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