Erythema Nodosum and Lung Ailments at the Clinic for Dermatological and Venereal Diseases in Sarajevo from 1989 to 2005

In  years period ( – ) we have treated at our Clinic a total of  patients diagnosed with erythema nodosum which makes , of the total number of patients treated in this period. In order to explore correlation between dermatological and lung diseases we applied statistical analysis with respect to number, sex, age and irregularities occurring on the skin surface. Female patients dominated with  of them (,) in the group, while only five patients were male (,). This makes  :  scale in favor of female patients, as opposed to usual : ratio. Similar predominance () was found in the study conducted by Mert and Gurkan (,). Average age of the patients was , years, which is slightly higher than the average of  and . The youngest patient was  and oldest .


Introduction
Erythema nodosum is an alergic reaction of the skin to different organic and nonorganic agents.It appears as a temporary emergence (eruption) of eflorescences appearing on the extensory side of lower extremities.It has not yet been established if erythema nodosum is a disease of immune system that leads to accumulation of immune complexes in blood vessels causing the inflammatory process in septaa between subcutaneous fat lobuli or if it is allergic reaction of the delayed kind ().Extensory side of the lower leg is the most frequent localization of erythema nodosum.In  patients (,) symptoms were exclusively found in that position, while  (,) of them exhibited erythema above the knee.Only  patients exhibited these changes on upper and lower extremities ().Common infectious causes of erythema nodosum are streptococcal, staphylococcal infections as well as leprous syphilis.Viral infections in most cases disease follow flu, morbiles, psittacosis, ornithosis, and the cat scratch disease.By order of frequency the first is streptococcal infection that occurred in all patients (,).Most of them had chronic tonsillitis.Staphylococcal infection preceded erythema nodosum in  cases (,).Tuberculosis etiology was recorded in  cases.Both of those were primary infections.Medicaments caused erythema nodosum was found in two cases.Both cases followed sulfonamide and analgesics treatment.Three pregnant women discovered erythema, one of them in the third month of pregnancy the other two in the fourth.In  patients pregnancy was discovered alongside erythema (,).Erythema nodosum is an inflammatory dermatosis which affects hypodermis and the fat tissue.The disease characterizes high febrillity and erythomatous areas on the extensory side of the lower leg, and sometimes on the hips and forearms.Palpation indicates that it is not only erythema but also painful to touch nodosum of few centimeters in diameter that never exulcerate (,,).Disease usually lasts for - weeks and it tends to relapse.

Methods and Materials
The study included all of the  patients who were diagnosed with erythema nodosum at the «Clinic for Dermatological and Venereal Diseases» in the last  years (Januar  to Decembar ).All of the patients were statistically analyzed with respect to number, sex, age, and irregularities that appeared on the skin surface.The study was focused on exploring correlation between dermatological and lung diseases.

Results
In the  years period we have treated a total of  patients diagnosed with erythema nodosum at our clinic which makes , of the total number of patients treated in this period as inpatients.
GENDER BREAKDOWN Predominant group was female including  of them (,), while only five patients were male (,).This creates  :  scale in favor of female patients, as opposed to usual  :  ratio (Graph ).Similar predominance () was found in the studies conducted by Mert A. and Gurkan (,).AGE Average age of the patients was , years, which is slightly higher than the average of  and .The youngest patients was  and oldest  (Graph ).LOCALIZATION OF THE SKIN CHANGES Extensory side of the lower leg is the most frequent localization of erythema nodosum.In  patients (,) symptoms were exclusively found in that position, while  (,) of them exhibited erythema above the knee.Only  patients exhibited these changes on upper and lower extremities ().

LABORATORY RESULTS
All the admitted patients were subjected to a round of routine lab checkups such as: PPD, ASTO, WAALER ROSE, Lung X ray, CT of thoracic organs.Most of the patients were tested for focuses.Accelerated erythrocyte sedimentation upon arrival was found in  patients (,) with average value of  in the first hour.Only  of the patients had regular sedimentation (,).In  patients extreme leukocytosis was registered in peripheral blood.Pathological changes in lungs were found in  patients out of  tested (,).X-rays registered bilateral increase of hilar lymphonods in  patients (,).Fearing sarcoidosis we referred all those patients to Pulmology Clinic for further treatment.Our results are within - range established by Criber ().

Discussion
Erythema nodosum is an inflammatory dermatosis that affects hypodermis and the fat tissue.Disease is characterized by high febrillity and erythomatous areas on the extensory side of the lower leg, and sometimes on the hips and forearms.Pulpation indicates that it is not only erythema but also painful to touch nodosum of few centimeters in diameter which never exulcerate.Disease usually lasts for - weeks and it tends to relapse (,).Erythema nodosum is considered to be an autoimmune response of the body to different (various) etiological agents, or a sign of decreased immunological defense of a body.In our sample concomitant illnesses were diabetes mellitus (in  cases), malignancy in  cases (both ovarian tumors), dermatomyositis in  patient and enteropathies in  patients.In  patients we were not able to determine etilogical factor, which concurs with the results of the research done in this area worldwide (,).We can conclude that our results are consistent with literature data that indicate significant gender differences and connection with decrease in immune response of the body (,).Erythema nodosum often appears as a side effect of sarcoidosis.In many cases it is the first symptom.Early diagnosis of sarcoidosis is of great importance so that therapy applied in timely manner.Therefore, the cooperation of pulmologists and dermatologists is of immense value ().

Conclusion
.In our sample it is proven (and consistent with literature data) that gender difference is an important finding among the patient with erythema nodosum..Most of the patients were  years old..Erythema nodosum is in the majority of cases prodromal sign of lung sarcoidosis..Early and correct diagnosis and adequate therapeutic approach are of crucial importance for therapeutical outcome and for the prevention of the underlined disease.

FARUK
ALENDAR: ERYTHEMA NODOSUM AND LUNG AILMENTS AT THE CLINIC FOR DERMATOLOGICAL AND VENEREAL DISEASES IN SARAJEVO FROM 1989 TO 2005