Septal panniculitis characterized by erythematous, warm, tender subcutaneous nodular lesions typically over anterior tibia. Lesions are usually flush with skin surface but are indurated and have appearance of an erythematous/violaceous bruise. Lesions usually resolve spontaneously in 3-6 weeks without scarring. Commonly seen in sarcoidosis, administration of certain drugs (esp. sulfonamides, oral contraceptives, and estrogens), and a wide range of infections including streptococcal and tubercular; may be idiopathic.
| TREATMENT | ||
Erythema NodosumIdentification and treatment/removal of underlying cause. NSAIDs for severe or recurrent lesions; systemic glucocorticoids are effective but dangerous if underlying infection is not appreciated. |
A reaction pattern of skin consisting of a variety of lesions but most commonly erythematous papules and bullae. “Target” or “iris” lesion is characteristic and consists of concentric circles of erythema and normal flesh-colored skin, often with a central vesicle or bulla.
Distribution of lesions classically acral, especially palms and soles. Three most common causes are drug reaction (particularly penicillins and sulfonamides) or concurrent herpetic or Mycoplasma infection. Can rarely affect mucosal surfaces and internal organs (erythema multiforme major or Stevens-Johnson syndrome).
| TREATMENT | ||
Erythema MultiformeProvocative agent should be sought and eliminated if drug-related. In mild cases limited to skin, only symptomatic treatment is needed (antihistamines, NSAID). For Stevens-Johnson syndrome, systemic glucocorticoids have been used but are controversial; prevention of secondary infection and maintenance of nutrition and fluid/electrolyte balance are critical. |
A common disorder, either acute or chronic, characterized by evanescent (individual lesions lasting <24 h), pruritic, edematous, pink to erythematous plaques with a whitish halo around margin of individual lesions. Lesions range in size from papules to giant coalescent lesions (10-20 cm in diameter). Often due to drugs, systemic infection, or foods (esp. shellfish). If individual lesions last >24 h, consider diagnosis of urticarial vasculitis.
| TREATMENT | ||
Urticaria |
Palpable purpura (nonblanching, elevated lesions) is the cutaneous hallmark of vasculitis. Other lesions include petechiae (esp. early lesions), necrosis with ulceration, bullae, and urticarial lesions (urticarial vasculitis). Lesions usually most prominent on lower extremities. Associations include infections, autoimmune diseases, primary systemic vasculitides, malignancy, hepatitis B and C, drugs, and inflammatory bowel disease. May occur as an idiopathic, predominantly cutaneous vasculitis.
| TREATMENT | ||
VasculitisWill differ based on cause. Pursue identification and treatment/elimination of an exogenous cause or underlying disease. If part of a systemic vasculitis, treat based on major organ-threatening features (Chap. 165 Vasculitis). Immunosuppressive therapy should be avoided in idiopathic, predominantly cutaneous vasculitis as disease frequently does not respond and rarely causes irreversible organ system dysfunction. |