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Erythema Nodosum

  • Epidemiologia
    • MOST COMMON panniculitis
    • Mostly occurs in the 2nd - 4th decade
    • M:F 1:3
  • Apresentação ClĂ­nica
    • Subcunateous, red, tender nodules usually on anterior shins, but can erupt anywhere
    • Contusiform evolution, never ulcerates (unlike erythema induratum)
    • May be associated with constitutional symptoms
    • Lasts 3-6 weeks, rarely “chronic”
    • May have associated edema around afected sites
  • Mecanismo
    • “Id-like” reaction to systemic issue - Imunocomplexos que se depositam perivasculares com reação granulomatosa
      • Infections (group A strep, TB, lepra)
      • Drugs
      • Malignancies
      • Inflammatory conditions
        • Sarcoidosis
          • Lofgren’s syndrome: bilateral hilar lymphadenopathy and erythema nodosum seen in sarcoid, good prognosis
        • Inflammatory bowel disease
          • In Crohn - Reflective of bowel disease activity (unlike pioderma gangrenosum)
        • Doenças auto-imunes
      Requena and SĂĄnchez Yus JAAD volume 45 number 2
      Requena and SĂĄnchez Yus JAAD volume 45 number 2
  • Histologia
    • Septal panniculitis without vasculitis (unlike Polyarteritis Nodosa)
    • Mixed infiltrate (PMN’s, histiocytes, lymphocytes, eosinophils)
    • Meischer’s radial granulomas
      • Histiocytes surrounding stellate or banana-shaped clefts
  • Tratamento
    • Treatment of underlying condition
    • Compression and elevation
    • NSAIDs
      • Naproxeno
      • Aspirin
    • Dermovate SOS
    • Ciclos de medrol
      • NĂŁo iniciar corticoterapia atĂ© excluir tuberculose como causa subjacente. Pode reactivar uma tuberculose
    • Iodeto de potĂĄssio 500 mg, lactose qbp 1 cĂĄpsula. FSA e mande em nÂș de 90
    • Tetracyclines
    • Colchicine
    • Dapsone
    • Hydroxychloroquine
    • Infliximab
    • Cyclosporine
    • Mycophenolate Mophetil