Osler Nodules

Osler nodules are skin lesions on the fingers and toes. They are small knots that cause pain. They often appear in hundreds next to each other.

Osler Nodules

What are Osler nodules?

Osler nodules were named after Canadian physician Sir William Osler. As the first author, he first described the abnormalities of his patients’ skin changes around 1900. The nodules are also known as Osler spots because they look like skin spots. The nodules are painful skin changes. See usvsukenglish for What does the abbreviation KiDD Syndrome stand for.

The pain arises as soon as pressure is applied to the affected area of ​​skin. Osler nodules are about the size of a pinhead to a pea. A special feature of the nodules is that they usually appear in numbers of several hundred at the same time. Their color is bluish red. The nodules are diagnosed on the fingers and toes.

They can also develop in the palms of the hands in the ball of the thumb or little finger. The skin changes are caused by bleeding in the dermis. This is the dermis that lies beneath the top layer of skin, the epidermis. Osler nodules are a common symptom of bacterial endocarditis.

In the case of patients, areas of skin of different sizes that are affected are often found on several fingers at the same time. It is characteristic that there is often a white area of ​​skin in the middle of the nodular patches. Once treatment is started, the nodules usually disappear after a few days.


Osler nodules arise from embolism or inflammation due to immune complex deposition in small arteries. For both reasons, the smallest drop of blood clogs the veins. This causes bleeding in the second layer of skin.

The most common cause of Osler nodules is bacterial endocarditis. Untreated infective endocarditis can be fatal. This is an inflammation of the inner lining of the heart. Osler nodules are a factorial and therefore not a compelling symptom of endocarditis. In addition, the pods occur in some other clinical pictures.

They include systemic lupus erythematosus, disseminated gonococcal infection, and septic catheter embolism. Systemic lupus erythematosus is an autoimmune disease of the skin and the vascular connective tissue of the organs. Lupus erythematosus is associated with inflammatory rheumatism.

Disseminated gonococcal infection is a special form of gonorrhea. In one to three percent of untreated gonorrhea, the disease progresses to a disseminated gonococcal infection. The patient suffers from bouts of fever, complains of joint problems and skin changes in the form of painful nodules.

Symptoms, Ailments & Signs

Osler nodules are primarily noticeable through noticeable skin changes. The characteristic nodules appear primarily on the toes and fingers. Painful growths occur there, which considerably limit the freedom of movement of hands or feet. The nodules range in size from a few millimeters to a few centimeters, increasing in size and hardening as the disease progresses.

As the nodules heal, the skin in the affected area will flake severely. This is usually accompanied by itching and redness. Depending on the cause, other symptoms can occur with Osler nodules. If the skin changes are due to infectious endocarditis , fever, chills and palpitations, among other things, occur.

Anemia and weight loss can also occur. If a heart defect is the cause, cardiac arrhythmia and a heart attack can 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.

At the same time, joint pain, symptoms of paralysis and the typical inflammatory reactions can occur. Osler nodules themselves resolve once the causative condition is treated. If left untreated, the growths will multiply and the accompanying symptoms will become more severe.

Diagnosis & course of disease

The diagnosis of Osler nodules is made by a dermatologist. Osler nodules are to be distinguished from Janeway lesions. These look very similar to the 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 also affect the mucous membranes, the gastrointestinal tract and skin areas on the face. Osler nodules affect skin changes on the tips of the fingers and toes. They can also occur on the palms of the hands or on the arms or legs.

However, they are not found inside the body. Their high number and their group-like appearance are characteristic. Further investigations are not necessary for Osler nodules and are not recommended. The diagnosis is made after the medical 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 doctor’s visit or an explicit diagnosis, the symptoms can decrease after a few days. This happens especially when the primary disease is identified and treated. If this is not done, it can be expected that the Osler nodules will recur.


In most cases, Osler nodules cause various changes and symptoms on the skin. The nodules themselves appear primarily on the toes or fingers and can thus lead to significant limitations and problems in the everyday life of those affected. The patient’s quality of life is significantly restricted and reduced due to the Osler nodules.

The nodules themselves are painful, leaving most sufferers unable to easily do many things with their fingers. It can also lead to psychological problems or even depression if the disease is not treated properly. In many cases, no simple diagnosis of Osler nodules is possible. The treatment itself usually proceeds without complications and is supported with the help of antibiotics.

Success comes relatively quickly. However, the skin flakes relatively strongly during the treatment. Many patients also suffer from inferiority complexes or a significantly reduced sense of self-esteem. As a rule, resting your hands and feet also has a very positive effect on Osler nodules. The life expectancy of the patient is not reduced with this disease.

When should you go to the doctor?

Reddish lumps on the toes and fingers, bleeding under the nails, and other signs of Osler nodules should be evaluated quickly. If the skin changes and pain do not go away on their own, medical advice is required. The affected persons should consult their family doctor, who can often diagnose Osler nodules by visual diagnosis. If necessary, further diagnostic measures must be initiated, for example a biopsy and imaging procedures, in order to be able to diagnose the disease with certainty. People who already have endocarditis need to tell their doctor about the nodules.

If the symptoms occur after a skin infection or another skin disease, medical advice is also required. Patients can visit the dermatologist or an internal medicine specialist. The treatment is usually drug-based and can be carried out by those affected at home. Close contact with the doctor must be maintained during therapy.

If side effects or other complications occur, the doctor must be informed. Osler nodules should resolve quickly if treated early. Further visits to the doctor are usually not necessary. However, the weakened skin is susceptible to further infections, which is why a dermatologist should be consulted regularly, at least in the first few weeks after recovery.

Treatment & Therapy

Treatment of Osler nodules depends on the cause. As long as this is not finally clarified, there will be a recurrence of the painful skin changes. In the case of endocarditis, cooperation with an internist is recommended. Depending on the stage, systemic lupus erythematosus is treated with an ointment or cortisone.

However, the ointment is not applied directly to the skin areas of the Osler nodules, as 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 found and treatment measures have been successfully initiated, Osler nodules usually heal without further medical intervention.

As the healing process continues, the skin gradually sheds the top layer of skin by itself via scaling. This process lasts for a few days and is usually painless for the patient. During this time, scratching movements or intentional rubbing of the skin surface should be avoided.

Skin-irritating or chemical products, for example from household cleaning, should not come into unprotected contact with the skin. Skin care products without the addition of alcohol can also be used as a support if desired. Activities that put pressure on the affected skin areas should be avoided.

It is advisable to take it easy on your hands, arms and legs for a few days. Wearing rubber gloves is only recommended when performing strenuous activities.

Outlook & Forecast

The development of Osler nodules – also known as Osler’s disease – is based on a genetic disease. This already includes the statement that such vascular changes cannot be cured. With most genetic diseases, only the after-effects and symptoms can be alleviated. With close monitoring of those affected and symptomatic therapy, Osler’s disease patients can experience a good quality of life.

Für Morbus Osler gilt, dass die symtomatischen Therapieansätze für viele der Betroffenen ein fast normales Leben gewährleisten. Was bei Osler-Knötchen grundsätzlich vermieden werden sollte, ist das Tauchen. Bei der Benutzung von Druckluftflaschen kann es zu einer Luftembolie kommen. Um die sonstige Prognose im positiven Bereich zu halten, sind regelmäßige Kontrollen beim behandelnden Arzt angeraten. Bestimmte Erkrankungen oder eine Schwangerschaft können beim Vorliegen von Osler-Knötchen zu schweren Komplikationen führen. Auch ein erhöhtes Alter kann die Prognose verschlechtern.

If complications involve involvement of internal organs, the prognosis worsens. Age and pregnancy can aggravate pulmonary arterial-venous malformations. It causes bleeding. Therefore, the prognosis varies from patient to patient. The course of the disease can also change over the course of life. While some patients with Osler-Knätchen only have minor symptoms, other sufferers experience life-threatening conditions due to a change in the course of the disease.


Preventative measures are not recommended for Oslo nodules. Since they are concomitant and side effects of some other diseases, intervention measures are possible for them. For example, hygiene must be observed when laying a catheter. Gonorrhea should also be treated immediately.


As a rule, those affected with an Osler nodule have only a few or only limited aftercare measures available. However, these are not always necessary, so that the disease does not always have to be treated directly. An early diagnosis has a positive effect on the further course of the disease and can also prevent the occurrence of further complications or symptoms.

The disease can usually be treated relatively well with the help of various medications. The person concerned 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.

If severe side effects occur, a doctor should also be consulted. Regular check-ups by a doctor during treatment are very useful. In general, the skin of the Osler nodule should be protected particularly well, whereby contact with the stimulating substances should be avoided. The disease does not reduce the life expectancy of the person affected.

You can do that yourself

Depending on the underlying cause of the Osler nodules and what treatment steps have already been taken, the patient can support the recovery with various self-help measures.

Above all, strict personal hygiene has proven its worth. The affected area must be treated with suitable preparations to prevent the formation of scales and other skin changes. At the same time, the patient should take it easy. 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.

During the further recovery process, the Osler nodules should not come into contact with any material and should never be rubbed open. Products that irritate the skin should be avoided in the first few days or weeks. This applies not only to personal hygiene, but also to household cleaning and professional activities. The responsible doctor 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 extensive consultation with a dermatologist.