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Erythema Nodosum

Lolwa Al-Obaid, MD, Faruq Pradhan, MBBCh and Frederic D. Gordon, MD, AGAF Reviewed 06/2018
 


BASICS

DESCRIPTION

  • A delayed-type hypersensitivity reaction to various antigens, or an autoimmune reaction presenting as a panniculitis (1) that affects subcutaneous fat

  • Clinical pattern of multiple, bi...

DIAGNOSIS

HISTORY

  • Often a prodrome 1 to 3 weeks prior to onset of lesions; can consist of malaise, fever, weight loss, cough, and arthralgia

  • Increasingly tender nodules on the legs, usually over the shi...

TREATMENT

  • Condition usually self-limited within 1 to 2 months

  • All medications listed as treatment for EN are off-label uses of the medications. There are no specific FDA-approved medications.

GENERAL MEASURES

ONGOING CARE

FOLLOW UP RECOMMENDATIONS

  • Keep legs elevated.

  • Elastic wraps or support stockings may be helpful when patients are ambulating.

Patient Monitoring

Monthly follow-up or as dictated by underlying...

REFERENCES

1
1 Chowaniec M, Starba A, Wiland P. Erythema nodosum—review of the literature. Reumatologia.  2016;54(2):79–82. {L-End} {L-End} [View Abstract on OvidMedline]
2
2 Schwartz RA, Nervi S...

ADDITIONAL READING

  • Bartyik K, Várkonyi A, Kirschner A, et al. Erythema nodosum in association with celiac disease. Pediatr Dermatol.  2004;21(3):227–230. {L-End} {L-End} [View Abstract on Ovid...

CODES

ICD10

  • L52 Erythema nodosum

  • A18.4 Tuberculosis of skin and subcutaneous tissue

ICD9

  • 695.2 Erythema nodosum

  • 017.10 Erythema nodosum with hypersensitivity reaction in tuberculosis, unspecified

SNOMED

  • 3286...

CLINICAL PEARLS

  • Lesions of EN appear to be erythematous patches, but when palpated, their underlying nodularity is appreciated.

  • Evaluation for a concerning underlying etiology is necessary in EN, but m...

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