Erythema nodosum

Notes

## Basic introduction

  • It is an acute, nodular, erythematous eruption restricted to the extensor aspects of the lower legs
  • It is a type of panniculitis (an inflammatory disorder affecting subcutaneous fat) with no vasculitis
  • It is thought to be an allergic reaction
  • It is closely related to:
  • Some systemic diseases
  • Drug therapies
  • Idiopathic causes
  • Causes of erythema nodosum include:
  • Throat infections (viral or bacterial)
  • TB
  • Oral contraceptives
  • Pregnancy
  • Drugs

|||Bromides

|||Gold salts.

|||Iodides

|||NSAIDS

|||Saliclyates

|||Sulphonamides

  • Inflammatory bowel disease
  • Sarcoidosis
  • Other unknown cause

## Statistics

  • Chronic or recurrent erythema nodosum is rare
Symptoms
  • Reddish, hot and painful lumps
  • Lesions located on the shin
  • Tender lumps or nodules
  • Lesions are often bilaterally distributed
  • Nodules heal without atrophy or scarring
  • There is no ulceration
Diagnosis
  • Clinical review
  • Biopsy may be required to confirm diagnosis
  • Additional tests:
  • Throat swab
  • CXR for TB
  • Sputum for AFB
  • Complete Blood Count
  • CRP
  • ESR
Differential
  • Nodular vasculitis
  • Alpha-1-anti-trypsin deficiency
  • Weber-Christian disease
  • Acute Urticaria
  • Erysipelas
  • Erythema Induratum
  • Insect Bites
  • Superficial Thrombophlebitis
  • Thrombophlebitis
Prevention

 

  • Avoid the offending drugs or chemicals
Reference
  1. White JM Jr: Erythema nodosum. Dermatol Clin 3:119-127, 1985
  2. Whig, J., Mahajan, V., Kashyap, A., & Gupta, S. (2010). Erythema nodosum: atypical presentation of common disease. Lung India: official organ of Indian Chest Society, 27(3), 181
  3. Tabak F, Murtezaoglu A, Tabak O, et al; Clinical features and etiology of adult patients with Fever and rash. Ann Dermatol. 2012 Nov 24(4):420-5. doi: 10.5021/ad.2012.24.4.420. Epub 2012 Nov 8
Management
  • The disease is self-limiting (lasting 3-6 wks)
  • NSAIDs
  • Oral corticosteroids
  • Colchicine may be useful
  • Cool wet compresses
  • Elevation
  • Bed rest
  • Others:
  • Tetracycline may be useful
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