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erythema_nodosum

erythema nodosum

introduction

  • painful red nodules usually over both shins (but may occur elsewhere) due to a hypersensitivity inflammatory reactions of the subcutaneous fat cells (panniculitis)
  • often associated with fever, malaise, and joint pain
  • nodules usually subside over a period of 2–6 weeks without ulceration or scarring
  • diagnosis is clinical but patients are usually investigated to exclude important causal precipitant conditions
  • an association with the HLA-B27 histocompatibility antigen, which is present in 65% of patients with erythema nodosum
  • peak incidence between 18–36 years of age
  • women are 3-6 times more affected than men

precipitant conditions

investigations

  • these should be targetted according to likely precipitants
  • FBE, ESR, ASOT, throat swab, urinalysis
  • CXR - hilar LNs may be due to TB, sarcoidosis or Löfgren syndrome (a form of acute sarcoidosis with erythema nodosum, bilateral hilar adenopathy, fever, and often accompanied by joint symptoms).
  • consider TB screen

treatment

  • Rx any streptococcal infection or other underlying cause
  • bed rest, elevation of legs, compressive bandages
  • non-steroidal anti-inflammatory drugs (NSAIDs) are more useful in acute forms
  • Corticosteroids and colchicine can be used in severe refractory cases
erythema_nodosum.txt · Last modified: 2012/08/31 00:52 by gary1