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At least 19 recordsLinked to original sources
PubMed2002

Erythema nodosum.

Erythema nodosum is the most frequent clinico-pathological variant of the panniculitides. The disorder is a cutaneous reaction consisting of inflammatory, tender, nodular lesions, usually located on the anterior aspects of the lower extremities. The process may be associated with a wide variety of diseases, being infections, sarcoidosis, rheumatologic diseases, inflammatory bowel diseases, medications, autoimmune disorders, pregnancy, and malignancies the most common associated conditions. The typical eruption consists of a sudden onset of symmetrical, tender, erythematous, warm nodules and raised plaques usually located on the shins, ankles and knees. Often the lesions are bilaterally distributed. At first, the nodules show a bright red color, but within a few days they become livid red or purplish, and finally they exhibit a yellow or greenish appearance taking on the look of a deep bruise. Ulceration is never seen and the nodules heal without atrophy or scarring. Some clinical variants of erythema nodosum have been described under different names, including erythema nodosum migrans, subacute nodular migratory panniculitis, and chronic erythema nodosum, but probably they are just clinical variants which may all be included within the spectrum of erythema nodosum. Histopathologically, erythema nodosum is the stereotypical example of a mostly septal panniculitis with no vasculitis. The septa of subcutaneous fat are always thickened and variously infiltrated by inflammatory cells that extend to the periseptal areas of the fat lobules. The composition of the inflammatory infiltrate in the septa varies with age of the lesion. In early lesions edema, hemorrhage, and neutrophils are responsible for the septal thickening, whereas fibrosis, periseptal granulation tissue, lymphocytes, and multinucleated giant cells are the main findings in late stage lesions of erythema nodosum. A histopathologic hallmark of erythema nodosum is the presence of the so-called Miescher's radial granulomas, which consist of small, well-defined nodular aggregations of small histiocytes arranged radially around a central cleft of variable shape. Treatment of erythema nodosum should be directed to the underlying associated condition, if identified. Usually, nodules of erythema nodosum regress spontaneously within a few weeks, and bed rest is often sufficient treatment. Aspirin, nonsteroidal anti-inflammatory drugs, such as oxyphenbutazone, indomethacin or naproxen, and potassium iodide may be helpful drugs to enhance analgesia and resolution. Systemic corticosteroids are rarely indicated in erythema nodosum and before these drugs are administered an underlying infection should be ruled out.

Diagnosis, Differential↗
PubMedDate not supplied

Tumour necrosis factor-alpha promoter polymorphism in erythema nodosum.

Erythema nodosum is a common skin disease characterized by erythematous, tender subcutaneous nodules, mostly located on the lower extremities. Little is known about its pathogenesis, although a wide variety of aetiological factors (e.g. bacterial and viral infections, neoplastic diseases and drugs) have been described. Sarcoidosis, a typical granulomatous disease, often occurs in association with erythema nodosum (Loefgren syndrome). Since granulomatous diseases have been closely linked to a deregulated tumour necrosis factor (TNF)-alpha production, it was tempting to speculate whether TNF-alpha might play a role in the pathogenesis of erythema nodosum, at least in cases associated with sarcoidosis. A previously described nucleotide exchange, (G-A) at position -308 in the human TNF-alpha gene promoter, has been shown to be a major cause for enhanced TNF-alpha production. In the present report, we investigated the genomic TNF-alpha promoter region in patients suffering from EN with and without underlying sarcoidosis. Our results showed a strong correlation between the uncommon TNF A II allele and sarcoidosis-associated erythema nodosum. Patients with erythema nodosum without underlying sarcoidosis displayed a similar allele frequency compared with controls. Taken together, we provide evidence that erythema nodosum in association with sarcoidosis might be pathogenically linked to altered TNF-alpha production due to a genetic promoter polymorphism.

Base Sequence↗
PubMed1999

Diagnosis: erythema nodosum or not?

Erythema nodosum is the final common pathway to a myriad of insults and is thought to be a hypersensitivity reaction centered in the subcutis. To recognize the histological spectrum of erythema nodosum, one must be aware of the morphologic chronology of the disease (early, fully developed, late) and its clinical variants (erythema nodosum migrans). This article reviews the range of changes that can be seen in this prototype of a septal panniculitis and describes the diversity that may be accepted in the diagnosis. Differential diagnoses at each stage of disease development are discussed. The criteria elaborated should assist the pathologist in answering the clinician's query, "Erythema nodosum, or not?"

Diagnosis, Differential↗
PubMed1991

The differential diagnosis of erythema nodosum.

Erythema nodosum is an uncommonly seen skin eruption which may be a marker of underlying systemic or infectious disease. It may also occur as a reaction to a variety of medications. The diagnosis of erythema nodosum should prompt a thorough investigation of possible causes or associated conditions which may be treatable. This paper presents a case of erythema nodosum and reviews the differential diagnosis of its causes and of similar appearing skin lesions.

Bacterial Infections↗
PubMed1992

Erythema nodosum.

Erythema nodosum represents an inflammatory process in the septa between the subcutaneous fat lobules. The hallmark lesions are exquisitely tender, erythematous nodules that are distributed symmetrically on the extensor surfaces of the lower extremities. Erythema nodosum is considered an immunologic response, and a wide variety of clinically important antigens have been implicated. It may serve as a cutaneous marker for systemic diseases, such as tuberculosis, sarcoidosis, inflammatory bowel disease and lymphoma. The disease is diagnosed by deep elliptical biopsy and pathologic evaluation. The natural history is resolution with treatment of the underlying disorder or spontaneous regression of idiopathic disease.

Diagnosis, Differential↗
PubMed1975

New observations in the histopathology of erythema nodosum.

Erythema nodosum presents variable clinical and histologic patterns of response in the vessels, septa, and fat lobules of the subcutaneous tissue. Acute or chronic phlebitis with hemorrhage may be commonly observed; acute panniculitis is observed in foci, but at time it may be the principal histologic feature; lymphocytic infiltration of fat lobules is often found, and lymphoid nodules are not infrequent; rarely, chronic granulomatous lesions involve septa or fat lobules; and proliferative lipocyte response may be observed. Because these variable histologic patterns may be coexistent, excision biopsy and multiple sections are necessary to recognize them. The variable histologic features correlate with the different clinical forms: acute nodular, chronic nodular, migrating plaque lesion, cellulitis, and the rate suppurative form. This variety of panniculus response in erythema nodosum can be explained on the basis of host-tissue response to a delayed hypersensitivity reaction to an antigenic stimulus.

Adipose Tissue↗
PubMed1991

Familial erythema nodosum.

Erythema nodosum (EN) is a hypersensitivity reaction associated with many diseases. We describe a family in which 4 sisters had acute or recurrent EN. HLA typing showed a common haplotype in the affected members of the family. A review of familial EN and HLA distribution in EN is presented.

Acute Disease↗
PubMed1976

Erythema nodosum.

Erythema nodosum (EN) is now more commonly associated with streptococcal disease than with tuberculosis. Sarcoidosis is the third most frequently associated systemic disease. Oral contraceptives now lead the list of drugs associated with EN. The appearance and disappearance of crops of nodules is extremely variable. Salicylates and rest are useful. Steroids are not recommended because they may compromise defenses against an underlying disease process.

Diagnosis, Differential↗
PubMed1985

Erythema nodosum.

Erythema nodosum is the most common and, in its classic form, the most easily recognized cause of inflammatory nodules on the legs. It is characterized by inflammatory, tender, nonulcerating, nonscarring nodules that are typically multiple and bilateral. The rather characteristic clinical presentation can be attributable to one of many causes or associated with a wide spectrum of systemic diseases. Diagnosis, evaluation, and treatment are discussed.

Adrenal Cortex Hormones↗
PubMed2004

Primary tuberculosis cases presenting with erythema nodosum.

Erythema nodosum (EN) is seen only in the primary tuberculosis (TB) form of tuberculous diseases. Among the etiologies of EN, TB is the most frequent disorder in developing countries. We aimed to assess our patients with EN in reference to primary TB. We evaluated 335 patients with the diagnosis of TB during last 20 years; retrospectively 61 (18%) of these cases had pulmonary and 274 (82%) had extrapulmonary TB. Ten (16%) of the pulmonary TB cases were primary. All 10 patients with primary TB presented with EN. Among 50 patients with EN diagnosed and followed during the last 10 years, the etiology was determined in 56%, and primary TB was the most frequent: 20%.

Adolescent↗
PubMed2001

Lichen planus, erythema nodosum, and erythema multiforme in a patient with chronic hepatitis C.

After identification of the hepatitis C virus (HCV) in 1989, evidence was established supporting its role in the pathogenesis of a number of cutaneous diseases. This evidence ranges from mere epidemiologic associations, such as lichen planus, to molecular biological investigations that have identified the virus in the pathologic tissues of cutaneous vasculitis, vasculitis with mixed cryoglobulinemia, and porphyria cutanea tarda. We describe a 52-year-old man who was diagnosed with chronic hepatitis C, preceding the appearance of lichen planus, erythema nodosum, and erythema multiforme that coincided with the reactivation of viral replication.

Erythema Multiforme↗
PubMed1976

Erythema nodosum and erythema multiforme associated with milker's nodules.

An epidemic of 44 cases of milker's nodules was recorded in the Tampere Central Hospital catchment area in Finland during the autumn of 1974. Exanthema or erythema multiforme-like secondary eruptions were seen in 10 cases. One female patient is reported in detail because of the simultaneous occurrence of erythema nodosum and erythema multiforme. The virological diagnosis was confirmed by electron microscopy.

Adult↗