Osler nodules are skin lesions on the fingers and toes. They are small nodules that cause pain. They often occur in hundreds next to each other.
What are Osler nodules?
Osler nodules were named after Sir William Osler, a Canadian physician. As the first author, he first described the abnormalities of his patients’ skin lesions around 1900. The nodules are also called Osler spots because they visually resemble skin spots. The nodules are painful skin lesions. The pain occurs as soon as pressure is applied to the affected area of skin. The Osler nodules are about the size of a pinhead to a pea. A distinctive feature of the nodules is that they usually occur in numbers of several hundred at a time. Their color is bluish-red. The nodules are diagnosed on the fingers and toes. In addition, they may appear in the palms of the hands in the pad of the thumb or little finger. The skin lesions are caused by hemorrhages in the dermis. This is the dermis, which is located under the top layer of skin, the epidermis. Osler’s nodules are a common accompaniment of bacterial endocarditis. Patients are often found to have skin areas of different sizes affected on several fingers at the same time. Characteristically, there is often a white area of skin in the center of the nodular patches. With the start of treatment, the nodules usually disappear after a few days.
Causes
Osler nodules are caused by an embolism or by inflammation due to immune complex deposition in small arteries. For either reason, tiny drops of blood clog the arteries. This causes the hemorrhages in the second layer of the skin. The most common cause of Osler nodules includes bacterial endocarditis. Untreated infective endocarditis can be fatal. It is an inflammation of the lining of the heart. The Osler nodules are a factorial and thus not a mandatory symptom in endocarditis. In addition, the nodules occur in several other medical conditions. These include systemic lupus erythematosus, disseminated gonococcal infection, and septic catheter embolism. Systemic lupus erythematosus is an autoimmune disease of the skin as well as the vascular connective tissue of the organs. Lupus erythematosus is classified as inflammatory rheumatism. Disseminated gonococcal infection is considered a special form of gonorrhea. In one to three percent of untreated gonorrhea, the disease progresses to Disseminated Gonococcal Infection. The patient suffers episodes of fever, complains of joint pain and skin lesions in the form of painful nodules.
Symptoms, complaints, and signs
Osler nodules are primarily noticeable through noticeable skin changes. The characteristic nodules develop mainly on the toes and fingers. Painful growths occur there, which considerably restrict the freedom of movement of the hand or foot. The nodules reach a size of a few millimeters to a few centimeters, increasing in size during the disease and becoming increasingly hardened. During the healing of the nodules, the skin in the affected area scales strongly. This is usually accompanied by itching and redness. Depending on the cause, Osler’s nodules may be accompanied by other symptoms. If the skin changes are due to infective endocarditis, fever, chills and palpitations may occur. In addition, anemia and weight loss may occur. If a heart defect is the cause, cardiac arrhythmias and even a heart attack may occur. The same applies if the Osler nodules are caused by an autoimmune disease of the skin. If inflammatory rheumatism is the trigger, further movement disorders occur. In parallel, there may be limb pain, paralysis and the typical inflammatory reactions. The Osler nodules themselves subside once the causative disease has been treated. In the absence of treatment, the growths multiply and the accompanying symptoms become more severe.
Diagnosis and disease progression
The diagnosis of Osler nodules is made by a dermatologist. Osler nodules should be distinguished from Janeway lesions. These look visually very similar to nodules, but are completely painless for the patient. In addition, they differ from the skin lesions of Osler’s disease.Here they are changes congenital and genetic. The diseased areas additionally affect the mucous membranes, gastrointestinal tract and skin areas on the face. Osler’s nodules affect skin changes on the tips of the fingers and toes. In addition, they can occur in the palms of the hands or on the arms or legs. However, they are not found inside the body. Their high number and group-like occurrence are characteristic. Further examinations are not necessary for Osler nodules and are not recommended. Diagnosis is made after history, visual inspection and pressure test. The latter should be associated with pain in the patient. A typical disease course of Osler nodules is classified as remitting. Even without a visit to the doctor or an explicit diagnosis, there may be a reduction in symptoms after a few days. This happens mainly when the primary disease is recognized and treated. If this is not done, the Osler nodules can be expected to recur.
Complications
In most cases, Osler nodules cause various changes and discomfort to the skin. The nodules themselves occur mainly on the toes or on the fingers and can thus lead to considerable limitations and discomfort in the daily life of the affected person. The patient’s quality of life is thus significantly restricted and reduced due to the Osler nodules. The nodules themselves are associated with pain, so that most of those affected can no longer do many things with their fingers without further ado. This can also lead to psychological discomfort or even depression if the disease is not treated properly. In many cases, no simple diagnosis is possible for Osler’s nodules. The treatment itself is usually without complications and is supported with the help of antibiotics. In this case, success is achieved relatively quickly. However, the skin scales relatively strongly during the treatment. Many patients also suffer from inferiority complexes or significantly lowered self-esteem. As a rule, sparing the hands and feet also has a very positive effect on the Osler nodules. The patient’s life expectancy is not reduced in this disease.
When should you go to the doctor?
Reddish nodules on the toes and fingers, bleeding under the nails, and other signs of Osler nodules should be evaluated quickly. If the skin lesions and pain do not resolve on their own, medical advice is needed. Affected individuals should consult their primary care physician, who can often diagnose Osler nodules by eye. If necessary, further diagnostic measures must be initiated, for example a biopsy as well as imaging procedures, in order to establish the disease beyond doubt. People who already suffer from endocarditis must inform the responsible physician about the nodules. If the symptoms occur after an infection of the skin or another skin disease, medical advice is also needed. Patients can consult the dermatologist or a specialist in internal medicine. Treatment is usually medicinal and can be carried out by the affected person at home. Close contact with the physician must be maintained during therapy. If side effects or other complications occur, the physician must be informed. Osler nodules should resolve quickly with early treatment. Further visits to the doctor are not normally necessary. However, the weakened skin is susceptible to further infections, so the dermatologist should be visited regularly, at least in the first few weeks after recovery.
Treatment and therapy
Treatment of Osler nodules depends on the cause. As long as this is not conclusively clarified, there is a recurrent occurrence of the painful skin lesions. In the case of endocarditis, cooperation with an internist is recommended. Systemic lupus erythematosus is treated with an ointment or cortisone, depending on the stage. However, the ointment is not applied directly to the skin areas of Osler’s nodules because the ingredients are tailored to the rheumatic symptoms. Disseminated gonococcal infection is treated with penicillin or antibiotics, depending on the pathogen.Provided that the cause of the nodules has been identified and treatment measures have been successfully initiated, Osler’s nodules usually heal without further medical intervention. As the healing process continues, the skin gradually sheds the top layer of skin by itself. This process lasts a few days and is usually painless for the patient. During this time, scratching movements or deliberate rubbing of the skin surface should be avoided. Skin-irritating or chemical products, for example from household cleaning, should not come into contact with the skin without protection. Skin care products without the addition of alcohol can be used in an additional supportive manner if desired. Activities that exert pressure on the affected skin areas should be avoided. Resting the hands, arms and legs for a few days is recommended. Wearing rubber gloves is recommended only during the performance of strenuous activities.
Outlook and prognosis
The development of Osler nodules – also known as Osler disease – is based on a genetic disorder. This already includes the statement that a cure is not feasible for such vascular changes. In most genetic diseases, only the sequelae and symptoms can be alleviated. With close monitoring of the affected person and through symptomatic therapy, patients with Osler’s disease can experience a good quality of life. For Osler disease, symtomatic therapy approaches ensure an almost normal life for many of those affected. What should generally be avoided in Osler nodules is diving. The use of compressed air cylinders can lead to air embolism. To keep the other prognosis in the positive range, regular check-ups with the attending physician are advised. Certain diseases or pregnancy can lead to severe complications in the presence of Osler nodules. Increased age may also worsen the prognosis. When complications involve internal organs, the prognosis worsens. Age and pregnancy can aggravate pulmonary arterial-venous malformation. It leads to hemorrhage. Therefore, the prognosis varies from patient to patient. The course of the disease may also change over a lifetime. While some patients with Osler’s nodules experience only mild symptoms, others experience life-threatening conditions due to a change in disease progression.
Prevention
Preventive measures are not recommended for Osler nodules. Because they are concomitant and secondary symptoms of some other diseases, intervention measures are possible in them. For example, attention should be paid to hygiene when placing a catheter. Likewise, gonorrhea should be treated immediately.
Follow-up
As a rule, only a few or even limited aftercare measures are available to those affected by an Osler nodule. However, these are also not always necessary, so direct treatment of the disease is not always required. Early diagnosis has a positive effect on the further course of the disease and can also prevent the occurrence of further complications or complaints. The disease can usually be treated relatively well with the help of various medications. The patient should always follow the doctor’s instructions and take the medication regularly and in the correct dosage. When taking antibiotics, it should also be noted that they should not be taken together with alcohol. In case of severe side effects, a doctor should also be consulted. During treatment, regular checks by a doctor are very useful. In general, in the case of Osler’s nodule, the skin should be particularly well protected, avoiding contact with the excitatory substances. The disease does not reduce the life expectancy of the affected person.
Here’s what you can do yourself
Depending on the underlying cause of the Osler nodules and what treatment steps have already been taken, the patient can support recovery through various self-help measures. Above all, strict body hygiene has proven to be effective. The affected area must be treated with suitable preparations to prevent the development of dandruff and other skin changes. At the same time, the patient should take it easy on himself.Especially after an operation, the affected area must not be exposed to any further stimuli in order to avoid serious complications. Hands, arms and legs must always be protected, preferably by wearing special gloves and sufficient bed rest. In the further recovery process, the Osler nodules should not come into contact with fabric and should not be rubbed under any circumstances. Skin-irritating products should be avoided during the first days to weeks. This applies not only to personal hygiene, but also to household cleaning and activities at work. The physician in charge can answer which measures are indicated in detail. Since Osler nodules can occur in very different forms and numbers, any self-help measures should only be used after comprehensive consultation with a dermatologist.
