Re: Causes, Treatments and Photos of EN

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Erythema nodosum Etiology This is a reaction pattern that occurs due to a variety of triggers (Fig. 18.54). The lesions are a septal panniculitis which is initially neutrophilic but later lymphocytic. Fig. 18.54 Causes of erythema

nodosum. Clinical features The lesions of erythema nodosum (EN) are red, tender, deeply placed nodules (Fig. 18.55), which become more bruise-like as they disappear over a few weeks. They usually occur on the shins, and are usually multiple and bilateral. Other sites, such as the thighs or arms, may also be affected, occasionally without lesions on the lower legs. There may be associated fever, malaise, arthralgia, sore throat, or cough, which are partly due to an acute-phase response, but also relate to the underlying causes. Elevated plasma viscosity, erythrocyte sedimentation rate, leukocytosis, thrombocytosis, and elevated complement C3 and C4 levels may occur as part of the acute

response. Investigations should be determined by the likely causes based on clinical history. Chest radiography is important in patients without a clinically obvious trigger, as about a third of cases are due to acute sarcoidosis, which may be suspected by finding bilateral hilar lymphadenopathy. Fig. 18.55 Examples of erythema nodosum. (a)–© The legs are the most common site, and the lesions are typically painful. A less common type, known as chronic or migratory erythema nodosum, occurs as a chronic disorder in middle-aged women. Treatment Acute attacks are usually treated with rest, NSAIDs, and occasionally systemic steroids, depending on severity of symptoms and the nature of any associated disorder. For more chronic lesions, potassium iodide, colchicine, intralesional steroids, antimalarials, dapsone, and immunosuppressive agents may all have benefit. You can help Erythema Nodosum Research. Just go to www.goodsearch.com and under the I'm Supporting section enter Erythema Nodosum Research Fund. Every time you use Goodsearch to search, a penny will be donated to EN Research. So sign up today, and be sure to tell your friends, family and co-workers. Let's find a cure for Erythema Nodosum!

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