Diagnosis, differential diagnosis, and management of erythema nodosum

Overview

Erythema nodosum represents the most frequent form of panniculitis. It may occur separately or as a part of wide range of many diseases. The clinical manifestation consists of an acute onset of painful erythematous nodules, which are predominantly localized symmetrically on a foreside of lower extremities. The nodules subsequently change the color from merely yellow to green. Onset of the disease may be accompanied by febrile status or other systemic manifestations. To differentiate erythema nodosum from other panniculitis or skin lesions of other etiology, the fact that erythema nodosum restores completely and skin atrophy, scars, or hyperpigmentation do not persist is helpful. Skin biopsy and histological finding of septal panniculitis without vasculitis may be of benefit, when the clinical picture is inconclusive. Nonsteroidal anti-inflammatory drugs are used in mild cases of a self-limited erythema nodosum. Systemic administration of glucocorticoids is indicated rarely and obviously in the most severe course of the disease. It is necessary to eliminate infection cause of the onset prior to administration of glucocorticoids. If the erythema nodosum occurs in an association with other diseases (non-specific or specific infections, reactive arthritis, sarcoidosis, idiopathic bowel inflammation, etc.), we treat the underlying disease.

Key words:
erythema nodosum, diagnosis, differential diagnosis, therapy