Rheumatoid nodules

Erythema marginatum

Erythema marginatum

Is described as the presence of pink rings on the trunk and inner surfaces of the arms and legs which come and go for as long as several months.

Causes

1. Infections
2. Bacteria: Escherichia coli , streptococcal infections
   
3. Fungi: Dermatophytes , Candida albicans and blue cheese Penicillium.
   
4. Mycobacteria: Mycobacterium tuberculosis.
   
5. Parasites: Ascaris lumbricoides
   
6. Viruses: (EBV) & was reported in an HIV-positive patient.
7. Drugs: In the cases of the antimalarials chloroquine and hydroxychloroquine, the eruptions took 5 months to a year to clear, and there are another many drugs ..
   
8. Neoplasms: Hodgkin disease, acute myelogenous leukemia (AML), and squamous cell carcinoma in a sebaceous cyst , and others …
9. Foods: Blue cheese and tomatoes have been reported to cause EAC.
   
10. Other causes
    

• Cholestatic liver disease
• Graves disease
  
• Hypereosinophilic syndrome
  
• Sjögren syndrome
  
• Sarcoidosis
  
• Osteoarthritis
  
• Stress
  
• Pregnancy

DDx

Cutaneous T-Cell Lymphoma Erythema Gyratum Repens Granuloma Faciale Lupus Erythematosus, Subacute Cutaneous

Management

Erythema annulare centrifugum (EAC) is usually self-limited. Topical steroids usually cause involution of the treated lesions, but they do not prevent the occurrence of new lesions or recurrence of the eruption.

SLE

Gout

N.B.
1-Gout usually presents as recurrent attacks of acute inflammatory arthritis (a red, tender, hot, swollen joint).
2-The joint that is most commonly affected is the first metatarsalphalangeal joint at the base of the big toe (approximately 75 % of first attacks) and when this occurs it is known as " podagra ".

DD :
1- Septic arthritis >> only can be ruled out by joint aspiration and culture .
2- Chondrocalcinosis " deposition of calcium pyrophosphate " .
3- Gouty tophi, particularly when not located in a joint, can be mistaken for basal cell carcinoma or other malignancies .


Prevention :
1- Life style modification "dietary modification " ...
2- Allopurinol ...
3- Probenecid ...
4- EDTA , as a chelating agent, ..


Management of the acute attacks :
1- Conservative by : Ice application ..
2-NSAIDs
3- Steroid ...
4- Colchicine ..