Erythema Nodosum Review Article Text

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During the first week, lesions become tense, hard, and painful during the second week, they may become fluctuant, as in an abscess, but do not suppurate or ulcerate. Individual lesions last approximately 2 weeks, but occasionally, new lesions continue to appear for 3 6 weeks. Erythema nodosum is inflammation of the fatty layer beneath the skin of the shins. Erythema nodosum is the most common form of the group of skin conditions called panniculitis. The skin often develops painful red lumps or plaques and will look darker and feel harder.

The condition may clear up on its own without treatment after some weeks, but for some people the condition will return. Erythema nodosum may occur as an isolated condition or in association with other conditions. Conditions that are associated with erythema nodosum include medications sulfa related drugs, birth control pills. Oestrogens , strep throat caused by the streptococcus bacteria , cat scratch fever, fungal diseases, glandular fever.

Behçet's disease, inflammatory bowel diseases crohn's disease and ulcerative colitis and normal pregnancy. Usually a doctor can make a straightforward diagnosis of erythema nodosum by simply examining a patient and noting the typical firm area of raised tenderness that is red, along with areas that have had lesions resolved, which might show a bruised like appearance. Sometimes a biopsy is done for confirmation for example if a patient has an isolated singular area and a doctor was unable to make a diagnosis based on its appearance. The biopsy of the deeper layers of tissue of skin can prove that it is erythema nodosum. Erythema nodosum is initially managed by identifying and treating any underlying condition present. Simultaneously treatment is directed towards relieving symptoms from inflamed skin from the erythema nodosum.

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Treatments for erythema nodosum include anti inflammatory drugs, and cortisone by mouth or injection. Potassium iodide may be used, as may tetracycline antibiotics for their anti inflammatory effects to reduce inflammation. It is important to note that erythema nodosum, while annoying and often painful, does not threaten internal organs and the long term outlook is generally very good.

Some of the more common infections are: erythema nodosum may occur with sensitivity to certain medications, including: antibiotics including amoxicillin and other penicillins sulfonamides sulfones birth control pills progestin other disorders linked to this condition include leukemia, lymphoma, sarcoidosis, rheumatic fever. University of medicine and dentistry of new jersey x2013 new jersey medical school, newark, new jersey erythema nodosum, a painful disorder of the subcutaneous fat, is the most common type of panniculitis. Generally, it is idiopathic, although the most common identifiable cause is streptococcal pharyngitis. Erythema nodosum may be the first sign of a systemic disease such as tuberculosis, bacterial or deep fungal infection, sarcoidosis, inflammatory bowel disease, or cancer. Certain drugs, including oral contraceptives and some antibiotics, also may be etiologic. The hallmark of erythema nodosum is tender, erythematous, subcutaneous nodules that typically are located symmetrically on the anterior surface of the lower extremities. Erythema nodosum does not ulcerate and usually resolves without atrophy or scarring.

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Most direct and indirect evidence supports the involvement of a type iv delayed hypersensitivity response to numerous antigens. A deep incisional or excisional biopsy specimen should be obtained for adequate visualization. Erythema nodosum represents an inflammatory process involving the septa between subcutaneous fat lobules, with an absence of vasculitis and the presence of radial granulomas.

Diagnostic evaluation after comprehensive history and physical examination includes complete blood count with differential erythrocyte sedimentation rate, c reactive protein level, or both testing for streptococcal infection i.e. Throat culture, rapid antigen test, antistreptolysin o titer, and polymerase chain reaction assay and biopsy. Purified protein derivative test, chest radiography, stool cultures varies based on the individual. 4 in children, the sex ratio is 1:1.2 peak incidence occurs in persons between 20 and 30 years of age, although erythema nodosum can occur at any age. It may also occur on other areas of the body such as buttocks, calves, ankles, thighs, and arms. The lesions begin as flat, firm, hot, red, painful lumps that are about an inch across.

Fever general ill feeling malaise joint aches skin redness, inflammation, or irritation swelling of the leg or other affected area typically, a diagnosis of erythema nodosum en is based on clinical features. However, other diseases manifest with inflammatory nodules of the lower limbs in addition to en, such as the en like lesions of beh x0e7 et's disease bd. The purpose of this retrospective study was to investigate the frequency of histologically proven en among diseases diagnosed clinically as en, to determine underlying causes of en, and to compare clinical and histologic features between en and other diseases. We selected 99 patients diagnosed clinically with en and performed skin biopsies. All pathologic slides were evaluated and diagnosed and after histologic diagnoses were made we reviewed the patients' medical records.

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Erythema nodosum en is a cutaneous reaction pattern characterized clinically by the presence of erythematous tender nodules and raised plaques, which are located predominantly over the extensor aspects of the legs. 4 6 these diseases share some clinical features, and therefore histopathologic study is required for a specific diagnosis. 4 clinical photographs were taken of all patients presenting with inflammatory nodules located on the lower limbs. Every patient then had a biopsy for diagnosis at the department of dermatology, ajou university hospital, suwon, korea, from january 20 through august 2005. We reviewed the photographs and selected 118 patients unanimously diagnosed by three dermatologists with en based on clinical features.

Of those, 19 patients were subsequently excluded because subcutaneous tissue specimens were insufficient for histopathologic evaluation. The degree of inflammatory cell infiltration in the dermis, fat lobules, and subcutaneous septa was graded as absent , mild + , moderate ++ , or marked +. The pattern of dermal inflammation was classified as perivascular, interstitial, or periappendageal infiltration. Panniculitis was classified as mostly septal, mostly lobular, or mixed septal and lobular when no clear compartmentalization of inflammatory cell infiltrates were observed.

When the number of neutrophils was greater than the number of lymphocytes, the infiltrate was considered predominantly neutrophilic or vice versa. We also assessed the presence and type of vasculitis by using the diagnostic criteria for leukocytoclastic vasculitis as described by barnhill et al. We reclassified all cases according to the results of histologic evaluation however, the diagnosis of bd was made by the international study group for beh x0e7 et's disease criteria. 9 thus we referred to the previous medical history for diagnosis of en like lesions in bd. Nodular vasculitis was diagnosed by the following histopathologic findings: vasculitis of arteries and veins, focal or extensive necrosis of fat lobules, predominantly lobular or septolobular panniculitis consisting of neutrophils, lymphocytes, and granulomatous inflammation. A consensus was reached that erythema induratum and nodular vasculitis would be considered the same entity. 5 nv is likely a reactive, immune complex mediated vasculitis, with tuberculosis as one of its etiologies.

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