erythema nodosum


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Related to erythema nodosum: erythema multiforme, sarcoidosis

Erythema Nodosum

 

Definition

Erythema nodosum is a skin disorder characterized by painful red nodules appearing mostly on the shins.

Description

Erythema nodosum is an eruption of tender red lumps on both shins and occasionally the arms and face. Bruising often accompanies the nodule formation. Erythema nodosum is most prevalent in young adults.

Causes and symptoms

Erythema nodosum can be caused by many important and treatable diseases. Among them are tuberculosis, several fungal lung infections, leprosy, inflammatory bowel disease, and some potentially dangerous bacterial infections. Drugs can also induce erythema nodosum. The most common are penicillin, sulfonamides, and birth control pills.

Diagnosis

There are a few other skin eruptions that mimic erythema nodosum, so the physician may have to perform a biopsy to sort them out. There are a few types of panniculitis, fat inflammation, that may signal a cancer somewhere in the body, and there are other kinds of inflammation that may confuse the diagnosis.
Once the skin problem has been diagnosed, its underlying cause must then be identified. A lengthy evaluation may ensue, and often times the cause remains unknown.

Treatment

Painful nodules can be treated with mild pain killers and local application of ice packs. Medical attention will be directed toward the underlying disease.
The nodules will eventually disappear, leaving no trace behind.

Resources

Books

Bennett, J. Claude, and Fred Plum, editors. Cecil Textbook of Medicine. Philadelphia: W. B. Saunders Co., 1996.

Key terms

Biopsy — Surgical removal of tissue for diagnostic purposes.
Panniculitis — Inflammation of fatty tissue.

erythema

 [er″ĭ-the´mah]
redness of the skin caused by congestion of the capillaries in the lower layers of the skin. It occurs with any skin injury, infection, or inflammation.
erythema chro´nicum mi´grans a ring-shaped erythema due to the bite of a tick of the genus Ixodes; it begins as an erythematous plaque several weeks after the bite and spreads peripherally with central clearing. Often there are also systemic symptoms, including chills, fever, headache, vomiting, backache, and stiff neck. See also lyme disease.
gyrate erythema (erythema gyra´tum) erythema multiforme characterized by the development of lesions that tend to migrate and spread peripherally with central clearing.
erythema ab ig´ne permanent erythema produced by prolonged exposure to excessive nonburning heat. It is seen most often on the legs of women, but under appropriate environmental circumstances, it can occur anywhere on the body in either sex.
erythema indura´tum a chronic necrotizing vasculitis, usually occurring on the calves of young women; see also bazin's disease.
erythema infectio´sum a mild, self-limiting disease of childhood characterized by a lacelike skin rash symmetrically distributed on the hands, arms, and legs, with few or no other symptoms; occasionally there is a low grade fever, and the condition often clears up without specific treatment. The incubation period is six days to two weeks. This disease is contagious and originally was believed to be a form of rubella; because the rash can resemble that of scarlet fever and German measles, it is important to differentiate this mild condition from those more serious ones. Called also fifth disease.
erythema margina´tum a type of erythema multiforme in which the reddened areas are disk-shaped, with elevated edges.
erythema margina´tum rheuma´ticum a superficial, often asymptomatic, form of gyrate erythema associated with some cases of rheumatic fever, which is characterized by the presence on the trunk and extensor surfaces of the extremities of a transient eruption of flat to slightly indurated, nonscaling, and usually multiple lesions.
erythema mi´grans geographic tongue.
erythema multifor´me a symptom complex representing a reaction of the skin and mucous membranes secondary to various known, suspected, and unknown factors, including infections, ingestants, physical agents, malignancy, and pregnancy. The conditions in the complex are characterized by the sudden onset of a reddened macular, bullous, papular, or vesicular eruption, the characteristic lesion being the iris, bull's eye, or target lesion, which consists of a central papule with two or more concentric rings. The complex includes a mild self-limited mucocutaneous form (erythema multiforme minor) and a severe, sometimes fatal, multisystem form (stevens-johnson syndrome).
erythema nodo´sum a type of panniculitis occurring usually as a hypersensitivity reaction to multiple provoking agents, including various infections, drugs, sarcoidosis, and certain enteropathies. It may also be of idiopathic origin. It most often affects young women and is characterized by the development of crops of transient, inflammatory, nonulcerating nodules that are usually tender, multiple, and bilateral, and most commonly located on the shins; the lesions involute slowly, leaving bruiselike patches without scarring. The acute disease is often associated with fever, malaise, and arthralgias. A chronic variant sometimes occurs without any serious associated systemic disease.
toxic erythema (erythema tox´icum) a generalized erythematous or erythematomacular eruption due to administration of a drug or to bacterial or other toxins or associated with various systemic diseases.
erythema tox´icum neonato´rum a benign, idiopathic, very common, generalized, transient eruption occurring in infants during the first week of life, usually consisting of small papules or pustules that become sterile, yellow-white, firm vesicles surrounded by an erythematous halo and some edema.

er·y·the·ma no·do·sum

a panniculitis marked by the sudden formation of painful nodes on the extensor surfaces of the lower extremities, with lesions that are self-limiting but tend to recur; associated with arthralgia and fever; may be the result of drug sensitivity or associated with sarcoidosis and various infections. Deep biopsies show a septal panniculitis with infiltration by lymphocytes and scattered multinucleated giant cells.
Synonym(s): nodal fever

erythema nodosum

a hypersensitivity reaction characterized by reddened, tender subcutaneous nodules on the extensor aspects of the extremities, such as the shins. The nodules last for several days or weeks, never ulcerate, and are often associated with mild fever, malaise, and pain in muscles and joints. This condition may accompany streptococcal infections, tuberculosis, sarcoidosis, drug sensitivity, ulcerative colitis, and pregnancy. The prognosis is good with appropriate treatment of the underlying condition. A course of corticosteroids is usually effective in diminishing the symptoms.
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Erythema nodosum

erythema nodosum

A nodular, erythematous eruption of acute onset, which is usually confined to the anterior and lateral lower legs (but also affects the arms, face and trunk), and is regarded as a delayed hypersensitivity reaction. While it usually resolves spontaneously, it may be chronic.

Clinical findings
Warm and tender nodules, bruise-like colours, bilateral, symmetrical, fever, and joint pain.

Demographics
More common in young (age 18–35) women (female:male ratio, 4:1); incidence is 25 cases/100,000/year.

Associations
Infections (especially streptococcus, but also cat-scratch disease), coccidiodomycosis, psittacosis, yersiniosis, sarcoid, inflammatory bowel disease, drugs (e.g., sulphonamides, halides, gold, sulfonylurea, oral contraceptives), lymphoma, oestrogen, neutrophilic dermatosis (Sweet syndrome, Behçet disease).
  
Management
NSAIDs, wet compresses, elevation, bed rest.

Erythema nodosum vs. nodular vasculitis:
Ulceration: No vs. Yes
Site: Shins vs. Calves
Onset: Acute vs. Chronic
Scars: No vs. Yes
Tissue: Septal vs. Lobular

er·y·the·ma no·do·sum

(er'i-thē'mă nō-dō'sŭm)
A panniculitis marked by the sudden formation of painful nodes on the extensor surfaces of the lower extremities, with lesions that are self limiting but tend to recur; associated with arthralgia and fever; may be the result of drug sensitivity or associated with sarcoidosis and various infections. Deep biopsies show a septal panniculitis (i.e., inflammation of fatty connective tissue), with infiltration by lymphocytes and scattered multinucleated giant cells.

erythema nodosum

Inflammation of small blood vessels (vasculitis) causing red, raised, tender nodules under the skin of both shins and sometimes elsewhere on the body. These disappear after some days or weeks. There may be fever, aches and pains and sickness. Erythema nodosum is an immunological disorder associated with a variety of conditions including TUBERCULOSIS, SARCOIDOSIS, streptococcal infections, drug allergies and LEPROSY.

erythema nodosum

dermatosis associated with drug sensitivity, sarcoidosis or infection; characterized by sudden onset, rapid, self-limiting (but recurrent) formation of lesions on leg extensor surfaces, sometimes with arthralgia and fever

erythema

redness of the skin caused by congestion of the capillaries in the lower layers of the skin. It occurs with any skin injury, infection or inflammation.

erythema ab igne
that due to exposure to radiant heat.
erythema chronicum migrans
the early skin rash at the site of the tick bite which infects humans with Borellia burgdorferi (Lyme disease); rarely seen in dogs.
erythema multiforme
a disease of unknown etiology, but is sometimes drug-related; presumed to be immune-mediated. It occurs in all species and is characterized by an acute onset of erythematous macules, papules, vesicles or bullae. There may also be fever, depression and anorexia.
erythema multiforme major
a rapidly fulminating, ulcerative form of erythema multiforme with involvement of oral mucosa and systemic signs.
necrolytic migratory erythema
in humans, a skin disease associated with glucagon-secreting tumors of the pancreas. The same association has not been observed in dogs, but disease of the liver and pancreas is often present. There are vesicles and crusted, ulcerated lesions, mainly on the face, mucocutaneous areas, distal limbs and feet.
erythema nodosum
a rare disorder in dogs characterized by fever, depression, arthralgia and septal panniculitis.
toxic erythema, erythema toxicum
a generalized erythematous or erythematomacular eruption due to administration of a drug or to bacterial toxins or other toxic substances.
References in periodicals archive ?
However, we should be more careful in the follow up of older sarcoidosis patients, because they have more frequent extrapulmonary symptoms and fewer good prognostic parameters, like erythema nodosum and Lofgren syndrome.
The FDA in the United States approved THALOMID on July 16, 1998 for the acute treatment of cutaneous manifestations of moderate to severe erythema nodosum leprosum (ENL) and as maintenance therapy for prevention and suppression of the cutaneous manifestations of ENL recurrence.
A forty-seven-year-old man had a history of recurrent oral aphthae and genital ulceration, anterior uveitis, and erythema nodosum that led to a diagnosis of BD 15 years ago.
His course was without complication by either reversal reaction or erythema nodosum leprosum.
PD predominantly occurs in patients with extrapulmonary tuberculosis (7), and the presence of erythema nodosum is one of the important hallmarks of the disease (1), although different immunologically-mediated clinical features associate with tuberculosis including erythematous eruption (8), urticaria (9), erythema induratum of Bazin (9), conjunctivitis (8), and oral ulcer (10) have been reported to occur.
Other clinical findings were gynaecomastia (greater on the right), infantile genitalia, lack of secondary sexual characteristics, facial atrophy, hyperpigmented knuckles and generalised erythema nodosum.
Evidence supporting an immune phenomenon includes the dramatic response to steroids and similarities with hypersensitivity reactions like erythema nodosum and erythema multiforme (3).
People with ulcerative colitis often have other disorders including arthritis, causing pain in the joints, and ankylosing spondylitis, causing pain in the spine, inflammation of the eye (uveitis), and the skin condition erythema nodosum.
2) In most cases, arthritis occurs as a part of Lofgren's syndrome, which is characterized by bilateral hilar lymphadenopathy and erythema nodosum.
It is important to identify Lofgren's syndrome (consisting of erythema nodosum, bilateral hilar adenopathy, migratory polyarthritis and fever), as not only does it have a good prognosis, but it is also made without the need for histological proof.
Most common forms of clinical presentation are recurrent oral and genital aphthous ulceration, uveitis and erythema nodosum (1).
In most of the other cases, sarcoidosis was with the symptoms of Lofgren syndrome (arthritis, erythema nodosum, bilateal hilar lymphadenopathy) whereas there was more systemic involvement in our case.