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Erythema Nodosum
What is Erythema Nodosum?
Erythema nodosum is an inflammation of the subcutaneous fat.
It presents as localized deep, red, extremely tender nodules with distinct
borders; older lesions resemble bruises (yellow-purple). Multiple lesions
are usually present, with the pretibial areas (lower extremity) usually
involved. Systemic symptoms such as fever and arthralgias may be present.
Erythema nodosum is a hypersensitivity reaction to a distant
site of infection or inflammation, caused possibly by circulating immune
complexes. There are numerous possible causes including: tuberculosis,
sarcoidosis, deep fungal infections (coccidiomycosis, histoplasmosis,
post-streptococcal infection, inflammatory bowel disease, Yersinia
enterocolitis, pregnancy, drugs (especially oral contraceptive pills), and
idiopathic.
With what can it be confused?
The diagnosis is usually not in doubt. Erythema nodosum can
resemble bruising (hematoma) or superficial thrombophlembitis.
How is it diagnosed?
Physical exam and a history that reveals a risk factor is
usually sufficient to make the diagnosis. The goal of laboratory investigations
is to confirm a possible cause for the condition. Throat culture or rapid
strep test, antistreptolysin O titer, chest radiograph, tuberculin skin test,
beta-HCG (for pregnancy), and gastrointestinal investigation (e.g. stool
studies, endoscopy) if bowel symptoms are present suggestive of inflammatory
bowel disease or infectious enterocolitis. Biopsy is not usually necessary.
How is it treated?
When identified, the underlying disease should be treated.
Pain and tenderness can be relieved with non-steroidal anti-inflammatory agents
(e.g. indomethacin). If an infectious cause is not suspected, a course of
systemic steroids (prednisone) can provide rapid relief. In chronic erythema
nodosum, compression stocking provide some relief.
What is the prognosis?
Erythema nodosum usually resolves within 3 to 6 weeks. Erythema
nodosum associated with inflammatory bowel disease may flare with the underlying
condition. Cutaneous complications, other than occasional scarring, does not
occur.
Date created 04/22/2007
Last updated
01/03/2009
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