A nodule refers to a palpable, round, quasi-round, or oval localized substantial lesion, mostly located in the dermis or subcutaneous tissue, with a diameter exceeding 1 cm.
Epidemiology
High-risk populationNon-specific disease population
symptom
Typical manifestationsNodules of different skin diseases develop in different locations. Nodules of basal cell carcinoma may be located within the epidermis; some may be located in both the epidermis and dermis; nodules of cutaneous tuberculosis, tertiary syphilis, and deep fungal infections may be located in the dermis and subcutaneous tissue; and nodules of lipomas and cysticercosis may be located in the subcutaneous tissue. Nodules are initially palpable but not visible, gradually increasing in size and rising above the skin surface. Nodules can be soft or hard. Some nodules feel immobile, indicating adhesion to surrounding tissue; most skin tumors manifest as this type of nodule. Gumma pallidum is a special type of nodule that exhibits granulomatous changes. Inflammatory nodules, such as erythema nodosum, may be painful, while non-inflammatory nodules, such as neoplasms, may present without any symptoms. A few nodules completely resorb on their own without leaving any traces, while most nodules change slowly or gradually increase in size. Some may ulcerate, forming ulcers, and leave scars after healing.
reason
OverviewThe causes of nodules are complex and diverse, and can be broadly categorized as infectious and non-infectious. Infectious nodules are often caused by pathogens such as bacteria and fungi, while non-infectious nodules can be caused by vascular lesions, tissue cell proliferation, and sometimes secondary to metabolic diseases. Identifying the cause is generally crucial for the treatment of nodules.
Cause of symptoms
1. Infectious diseases
Including nodules caused by bacteria, fungi, and parasites, such as leprosy, sporotrichosis, cutaneous cysticercosis, syphilis, etc.
2. Non-infectious diseases
(1) Vascular diseases, such as Wegener’s granulomatosis.
(2) Histiocytic proliferative diseases, such as cutaneous lymphocytoma.
(3) Metabolic diseases, such as xanthomas.
(4) Chronic granulomatous pulmonary infection, such as sarcoidosis.
(5) Autoimmune diseases, such as rheumatoid arthritis.
Common diseases
Leprosy, sporotrichosis, cutaneous cysticercosis, Wegener’s granulomatosis, cutaneous lymphocytoma, xanthomatosis, sarcoidosis, rheumatoid arthritis, etc.
Seeking medical treatment
Outpatient indications
1. One or more nodules are palpated;
2. The nodules gradually increase in size and persist;
3. The nodules are tender;
4. Local skin has redness, swelling, ulcers, etc.;
5. Accompanied by systemic symptoms such as fever, fatigue, weight loss, and decreased appetite;
6. Nodules appear in special locations, such as joints, accompanied by joint stiffness, movement disorders, etc.
7. Other severe, persistent or progressive symptoms and signs occur.
All of the above require prompt medical consultation.
Treatment departmentDoctors may, depending on the situation, refer patients to departments such as dermatology and oncology for diagnosis and treatment.
Medical preparation
1. Make an appointment in advance and bring your ID card, medical insurance card, medical card, etc.
2. Pay attention to personal hygiene and keep the affected area clean and dry.
3. Do not scratch the affected area to prevent secondary infection.
4. Try to wear loose clothes when seeing a doctor so that the doctor can check the condition of the lesion and the surrounding skin.
5. If you have had medical treatment recently, please bring relevant medical records, examination reports, laboratory test results, etc.
6. If you are taking some medicine to relieve symptoms recently, you can bring the medicine box with you.
7. Family members can be arranged to accompany the patient to seek medical treatment.
8. Patients can prepare a list of questions they want to ask in advance.
What questions might a doctor ask a patient?
1. When did you discover the nodules on your skin? Where are they located on your body?
2. Did the nodules on your skin appear suddenly or gradually?
3. Have the shape, size, number, or color of the nodules changed over time?
4. Do you experience pain, itching, etc. at the lesion?
5. Have you ever experienced a similar situation before? What caused it?
6. Have you ever been infected with bacteria, fungi or parasites?
7. Have you ever been diagnosed with any skin disease?
8. Do you have a history of rheumatoid arthritis, syphilis, etc.?
9. Do you like to eat foods high in fat? Do you smoke or drink alcohol frequently? Do you have high blood lipids?
10. Have you tried treatment?
What questions can patients ask their doctor?
What is the most likely cause of my nodules? Are there other possible causes?
2. What tests do I need to do?
3. Will the nodules disappear on their own? Is treatment necessary? What are the risks of not treating them?
4. If treatment is necessary, what treatments are available to me? Are there any risks associated with these treatments?
5. Can it be cured? Will it recur?
6. What should I pay attention to in daily life?
7. If medication is needed, what are the usage, dosage, and precautions?
examine
Scheduled inspectionThe doctor will first conduct a physical examination to understand the specific situation of the nodule lesions and make a preliminary diagnosis of the cause of the nodules. The doctor will then select appropriate laboratory tests based on the patient’s condition to further clarify the cause of the nodules.
Physical examinationThe doctor will carefully observe the size, number, shape, color, hardness, location, distribution and arrangement of the nodules, whether they are tender, whether they appear suddenly or gradually, whether they ulcerate, and whether there are scars after they disappear, in order to preliminarily determine the cause of the nodules.
Laboratory tests
The main tests include blood routine, serological tests, tuberculin test, fungal microscopy and culture, and Kveim test, all of which are helpful in diagnosing the cause of nodules. Doctors will choose the appropriate method based on the patient’s specific situation.
Pathological examinationIf necessary, the doctor may take part of the nodule biopsy tissue and send it to the pathology department for examination to further clarify the nature of the nodule tissue, which is of great significance for the diagnosis of the cause of the nodule.
diagnosis
Diagnostic principles
Diagnosis is usually straightforward based on the patient’s medical history, specific findings such as the location, tenderness, and number of nodules, as well as laboratory test results. Diagnosis of the etiology is crucial for selecting treatment options. Physicians often need to differentiate between rheumatoid nodules, syphilitic nodules, lepromatous leprosy, and xanthomas.
Differential diagnosis
1. Rheumatoid nodules
Rheumatoid arthritis is a characteristic skin lesion characterized by hemispherical, raised subcutaneous nodules that vary in size from 2.0 cm to 2.5 cm or larger, are firm, generally nontender, and may or may not adhere to the skin. They are located over joint prominences, most commonly on the elbows, but can occur in connective tissue throughout the body. Nodules can persist for a long time or disappear spontaneously, generally without rupturing. Pathological changes include accumulation of proteinaceous material and palisade-like tissue cells in the subcutaneous tissue or dermis. Laboratory tests show a positive RF. Non-treponemal antigen tests may be negative, but treponemal antigen tests may be negative.
2. Syphilitic nodules
Nodules appear in the tertiary stage of syphilis. Subcutaneous nodules occur symmetrically near large joints such as the hips, elbows, knees, and sacral joints. They are hard, with no inflammation of the overlying skin and slight pain at any time. They are 1 to 2 cm in size, do not rupture, and may resolve with treatment. RF (negative) and non-treponemal antigen tests and treponemal antigen tests are both positive. There is a history of prostitution and a history of chancre.
3. Lepromatous leprosy
Leprosy is a chronic infectious disease caused by Mycobacterium leprae. It primarily affects the skin and peripheral nerves. Symptoms include infiltrative plaques and nodules, as well as sensory loss, eyebrow loss, sweating, and enlarged nerves. Histological examinations are positive for the bacterium.
4. Tuberous xanthoma
It is common in patients with hyperlipidemia and elevated cholesterol. Pathologically, it is characterized by the presence of foam cells and multinucleated Tonton giant cells.
treat
Expected treatmentThe doctor will first determine the cause and then choose the appropriate treatment method. Usually, after the primary disease is well treated, the nodule will gradually become smaller or even disappear.
Treatment
1. Cutaneous lymphocytoma
Conservative treatment with medication, surgical resection, cryosurgery, laser and radiotherapy can also be used.
2. Cutaneous cysticercosis
The main treatment methods are drug therapy and surgical treatment. Commonly used drugs include praziquantel and albendazole.
3. Sporotrichosis
Drug treatment is the main method to control infection.
4. Rheumatoid arthritis
Most cases require lifelong treatment. Treatment primarily involves medication, exercise, lifestyle changes, and, if necessary, surgery. The primary goal is to control the condition and prevent it from worsening.
Related drugsPraziquantel, albendazole