Erythema nodosum: a sign of systemic disease.

Full Abstract

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. 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, antistreptoly-sin-O titer, and polymerase chain reaction assay); and biopsy. Patients should be stratified by risk for tuberculosis. Further evaluation (e.g., purified protein derivative test, chest radiography, stool cultures) varies based on the individual. Erythema nodosum tends to be self-limited. Any underlying disorders should be treated and supportive care provided. Pain can be managed with nonsteroidal anti-inflammatory drugs.

Learn Faster Today Improve your study skills

Author information

Author/s: Schwartz, Robert A (RA); Nervi, Stephen J (SJ);

Affiliation: University of Medicine and Dentistry of New Jersey-New Jersey Medical School, Newark, New Jersey, USA. roschwar(-atsign-)cal.berkeley.edu

Journal and publication information

Publication Type: Journal Article; Review

Journal: American family physician (Am Fam Physician), published in United States. (Language: eng)

Reference: 2007-Mar; vol 75 (issue 5) : pp 695-700

Dates: Created 2007/03/22; Completed 2007/04/12;

PMID: 17375516, status: MEDLINE (last retrieval date: 12/26/2008)

Sourced from the National Library of Medicine. Abstract text and other information may be subject to copyright.

External Links for this article (including full text providers, if available):

Click Electronic Full-text Provider Links to see options for finding the electronic full text links to this article. Note there may be a subscription or fee required for access to the full text. See our FAQ for information on finding FREE full text articles.

This article may also be located in paper journal collections available in many libraries. Use the Journal and Publication Information above to find the full article.

MeSH headings (categories)

This article was linked to the MESH Headings shown below.

Autoimmune Diseases - complications
Diagnosis, Differential
Drug Hypersensitivity - complications
Erythema Nodosum - diagnosis; etiology; physiopathology; therapy
Humans
Mycoses - complications

Neoplasms - complications
Pharyngitis - complications
Sarcoidosis - complications
Streptococcal Infections - complications
Streptococcus pyogenes
Tuberculosis - complications

These are the highest related articles currently in the database:

Erythema nodosum. 30 May 1969
[Targetted antibiotic therapy. Acute sore throat: streptococcus A update] 30 Oct 1994
Principles of appropriate antibiotic use for acute pharyngitis in adults: background. 30 May 2001
Microbiological diagnosis of streptococcal pharyngitis: lacunae and their implications. 30 Mar 2006
[Erythema nodosum in childhood. Nosographical classification and case studies] 29 Jun 1977
[Pathogenesis of erythema nodosum in the light of modern views] 29 Apr 1975
Sore throat, antibiotics and rheumatic fever. 30 May 1985
Management of streptococcal pharyngitis reconsidered. 30 Aug 1985
Erythema nodosum. 29 Nov 1973
Fluorescein and indocyanine green angiography findings in a case of poststreptococcal syndrome with erythema nodosum and posterior uveitis. 30 Dec 2000

See 100+ related articles.