Erythema nodosum
Background
- Often marker for systemic disease
- Most common in women 30-50 years of age
- 1:6 male to female
- Usually a self-limited disease, resolving in 3-6 wks
Associated Disease Processes
- Drug induced (OCPs, sulfonamides, PCN)
- Tuberculosis
- Fungal disease (Coccidioidomycosis, Histoplasmosis)
- Sarcoidosis
- Ulcerative colitis
- Crohn's disease
- Behcet's disease
- Cat scratch disease
- Mononucleosis
- Streptococcal pharyngitis
- Normal pregnancy
- Malignancy (leukemia, lymphoma)
Clinical Features
Erythema nodosum in a person who had recently had streptococcal pharyngitis
A single lesion of erythema nodosum.
- Painful
- Non-ulcerative nodules
- Violaceous, erythematous
- Usually anterior tibia, arms, trunk
Differential Diagnosis
- Erysipelas
- Erythema induratum (nodular vasculitis)
- Familial Mediterranean Fever
- Insect bites
- Superficial thrombophlebitis
- Thrombophlebitis
- Urticaria
Evaluation
Erythema nodosum. (A) Symmetric, smooth and shiny, erythematous nodules affecting the both shins of the parient. (B) Classical appearance of septal inflammation.
- Clinical diagnosis
Management
- Treat underlying cause
- NSAIDs
- Potassium Iodide
- RICE, cool wet compresses
Disposition
- Typically outpatient
References
- Hebel et al. Erythema Nodosum. Apr 13, 2015. http://emedicine.medscape.com/article/1081633-overview
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