Erythema Nodosum
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Basics
Description
- A delayed-type hypersensitivity reaction to various antigens, or an autoimmune reaction presenting as a panniculitis (1) that affects subcutaneous fat
- Clinical pattern of multiple, bilateral, erythematous, tender nodules in a typically pretibial distribution that undergo a characteristic pattern of color changes, similar to that seen in bruises. Unlike erythema induratum, the lesions of erythema nodosum (EN) do not typically ulcerate.
- Occurs most commonly on the shins; less commonly on the thighs, forearms, trunk, head, or neck
- Often associated with nonspecific prodrome including fever, weight loss, and arthralgia
- Often idiopathic but may be associated with a number of clinical entities
- Usually remits spontaneously in weeks to months without scarring, atrophy, or ulceration
- Uncommon to have recurrences after initial presentation
Pregnancy Considerations
May have repeat outbreaks during pregnancy
Pediatric Considerations
Rare pediatric variant has lesions only on palms or soles, often unilateral; typically has a shorter duration in children than adults
Epidemiology
Incidence
- 1 to 5/100,000/year
- Predominant age: 20 to 30 years
- Predominant sex: female > male (6:1) in adults
Prevalence
- Varies geographically depending on the prevalence of disorders associated with EN
- Reported 1 to 5/100,000
Etiology and Pathophysiology
- Idiopathic: up to 55%
- Infectious: 44%. Streptococcal pharyngitis (most common), mycobacteria, mycoplasma, chlamydia, mycoplasma, coccidioidomycosis, rarely can be caused by Campylobacter spp., rickettsiae, Salmonella spp., psittacosis, syphilis
- Sarcoidosis: 11–25%
- Drugs: 3–10%; sulfonamides amoxicillin, oral contraceptives, bromides, azathioprine, vemurafenib
- Pregnancy: 2–5%
- Enteropathies: 1–4%; ulcerative colitis, Crohn disease, Behçet disease, celiac disease, diverticulitis
- Rare causes: <1% (2)
- Fungal: dermatophytes, coccidioidomycosis, histoplasmosis, blastomycosis
- Viral/chlamydial: infectious mononucleosis, lymphogranuloma venereum, paravaccinia, HIV, hepatitis B, C
- Malignancies: lymphoma/leukemia, sarcoma, myelodysplastic syndrome
- Sweet syndrome
Risk Factors
See “Etiology and Pathophysiology.”
Commonly Associated Conditions
See “Etiology and Pathophysiology.”
-- To view the remaining sections of this topic, please log in or purchase a subscription --
Basics
Description
- A delayed-type hypersensitivity reaction to various antigens, or an autoimmune reaction presenting as a panniculitis (1) that affects subcutaneous fat
- Clinical pattern of multiple, bilateral, erythematous, tender nodules in a typically pretibial distribution that undergo a characteristic pattern of color changes, similar to that seen in bruises. Unlike erythema induratum, the lesions of erythema nodosum (EN) do not typically ulcerate.
- Occurs most commonly on the shins; less commonly on the thighs, forearms, trunk, head, or neck
- Often associated with nonspecific prodrome including fever, weight loss, and arthralgia
- Often idiopathic but may be associated with a number of clinical entities
- Usually remits spontaneously in weeks to months without scarring, atrophy, or ulceration
- Uncommon to have recurrences after initial presentation
Pregnancy Considerations
May have repeat outbreaks during pregnancy
Pediatric Considerations
Rare pediatric variant has lesions only on palms or soles, often unilateral; typically has a shorter duration in children than adults
Epidemiology
Incidence
- 1 to 5/100,000/year
- Predominant age: 20 to 30 years
- Predominant sex: female > male (6:1) in adults
Prevalence
- Varies geographically depending on the prevalence of disorders associated with EN
- Reported 1 to 5/100,000
Etiology and Pathophysiology
- Idiopathic: up to 55%
- Infectious: 44%. Streptococcal pharyngitis (most common), mycobacteria, mycoplasma, chlamydia, mycoplasma, coccidioidomycosis, rarely can be caused by Campylobacter spp., rickettsiae, Salmonella spp., psittacosis, syphilis
- Sarcoidosis: 11–25%
- Drugs: 3–10%; sulfonamides amoxicillin, oral contraceptives, bromides, azathioprine, vemurafenib
- Pregnancy: 2–5%
- Enteropathies: 1–4%; ulcerative colitis, Crohn disease, Behçet disease, celiac disease, diverticulitis
- Rare causes: <1% (2)
- Fungal: dermatophytes, coccidioidomycosis, histoplasmosis, blastomycosis
- Viral/chlamydial: infectious mononucleosis, lymphogranuloma venereum, paravaccinia, HIV, hepatitis B, C
- Malignancies: lymphoma/leukemia, sarcoma, myelodysplastic syndrome
- Sweet syndrome
Risk Factors
See “Etiology and Pathophysiology.”
Commonly Associated Conditions
See “Etiology and Pathophysiology.”
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