Erythema nodosum

Synonym(s)

Dermatitis contusiformis; erythema con-tusiformis; focal septal panniculitis; nodose fever

Definition

Inflammatory vascular reaction pattern to multiple causes; characterized by tender subcutaneous nodules, usually on the anterior legs

Pathogenesis

Probably is delayed hypersensitivity reaction to a variety of antigens; most common associations with streptococcal infections in children and sarcoidosis in adults; other associations include tuberculosis, myco-plasma pneumonia, leprosy, coccidioid-omycosis, North American blastomycosis, histoplasmosis, inflammatory bowel disease, pregnancy, and Behcet's disease; associated medications include oral contraceptives and sulfonamides

Clinical manifestation

Prodrome of flulike symptoms of fever and generalized aching; lesions begin as poorly-defined, red, tender nodules; become firm and painful during the second week; sometimes becoming fluctuant; not suppurating or ulcerating; individual lesions last approximately 2 weeks; associated leg edema and pain

Differential diagnosis

Nodular vasculitis; insect bite reaction; erysipelas; cellulitis; superficial thrombophle bitis; Weber-Christian disease; pancreatic panniculitis; lupus profundus; traumatic panniculitis; polyarteritis nodosa; rheumatoid nodules

Therapy

Non-steroidal anti-inflammatory agents; bed rest; leg elevation; prednisone

References

Requena L, Requena C (2002) Erythema nodosum. Dermatology Online Journal 8(i):4

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