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A. Characteristics

  1. Subcutaneous septal panniculitis (inflammation of fat)
  2. Inflammatory reaction in subcutaneous fat
  3. Acute and Chronic variants

B. Associations

  1. Infections
    1. ß-hemolytic streptococci - most common cause
    2. Certain fungi - especially coccidiomycosis
    3. Tuberculosis [3]
    4. Leprosy - called erythema nodosum leprosum
    5. Parvovirus B19 infection
  2. Drugs
    1. Sulfonamides
    2. Oral contraceptives
  3. Chronic Inflammatory Diseases
    1. Sarcoidosis [2]
    2. Inflammatory Bowel Disease
    3. Behcet's Disease
    4. Wegener's Granulomatosus
  4. Idiopathic
  5. May be related Th1 cytokine imbalance

C. Symptoms

  1. Most commonly occurs on lower legs
  2. Tender erythematous nodules
  3. Pain is often greater than appearance
  4. Flatten over time, appear like a bruise with scarring
  5. Sarcoid-associated erythema nodosum
    1. Particularly in young women
    2. Erythema nodosum, hilar lymphadenopathy, polyarthralgia is Lofgren's Syndrome [4]

D. Treatment

  1. Directed toward undlerlying condition
    1. Check PPD (tuberculin) and chest radiograph
    2. Evaluation for sarcoidosis, inflammatory bowel disease
    3. Rule out other causes
  2. Treat probably underlying conditions
  3. Non-steroidal anti-inflammatory agents (NSAIDs) may be effective
  4. Resistant erythema nodosum often responds to glucocorticoids

References

  1. Labbe L, Perel Y, Maleville J, Taieb A. 1996. Pediatr Dermatol. 13(6):447 abstract
  2. Cancrini C, Angelini F, Colavita M, et al. 1998. Clin Exp Rheumatol. 16(3):337 abstract
  3. Kassutto S and Daily JP. 2004. NEJM. 351(14):1438 (Case Discussion) abstract
  4. Bates PW and Mark EJ. 2001. NEJM. 344(6):443 (Case Record)