Erythema Nodosum

by Carlo Raj, MD

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    00:01 Our topic now brings us to erythema nodosum.

    00:06 Right off the bat, I’m just going to tell you what’s happening with nodosum.

    00:08 We’ve seen this a few times already.

    00:10 Now, we’re just going to summarize what’s actually happening in dermatology.

    00:14 Most commonly, it would be located on the anterior aspect of the legs down by the shin.

    00:18 Can you go down there for me, please, and picture that? And upon palpation, this hurts, it hurts.

    00:25 This is also known as panniculitis.

    00:27 Welcome to erythema nodosum.

    00:30 Involves the septa between the fat lobules.

    00:34 I’m going to stop here for one second.

    00:36 So, if you were to take a look at the anterior aspect of the shin or the shin in general, and you notice there is erythema and it’s painful and maybe a little bit of yellow discoloration, which is not uncommon, this is because it’s involving the septa between the fat lobule.

    00:53 Usually idiopathic.

    00:54 However, there is a long list of causes, long list.

    00:57 I can’t just say that it’s caused by sarcoidosis.

    01:01 I cannot just say that it’s caused by coccidioides.

    01:04 I can tell you that it’s caused by whole -- or should I say it’s a sequelae or manifestation that you’re going to find with the whole host of systemic fungal infections or infections in general.

    01:15 May be non-infectious such as sarcoidosis.

    01:19 So may be secondary to inflammation including infections, coccidioides, Histoplasma, blastomycosis, autoimmune diseases, maybe medications, and maybe hormonal, perhaps, oral contraceptive pills.

    01:33 What are you paying attention to with erythema nodosum? You’re down by the shin, and apart from the erythema, there might a lipid or yellow type of appearance, and it’s painful.

    01:45 Another name for this is panniculitis.

    01:49 Morphology: Tender, subcutaneous nodule on the anterior shin, most commonly.

    01:55 Could you find this on other locations? Sure, you can, but go with what’s most common, I beg of you.

    02:01 Morphology.

    02:02 Take a look at the shin of your patient.

    02:05 Raised, erythematous, painful nodule on the anterior shin.

    02:11 As soon as you hear this, you know that you’re looking for an underlying cause, right? That’s your clinical approach.

    02:17 So, it’s not like you’re seeing this and you’re treating the erythema nodosum.

    02:20 That would only be symptomatic.

    02:22 I mean, what you’re really going after is, wow, what’s the underlying disorder of my patient that is then resulting in such a manifestation? Pathology: Inflammation involving the subcutaneous fat.

    About the Lecture

    The lecture Erythema Nodosum by Carlo Raj, MD is from the course Inflammatory Skin Diseases.

    Included Quiz Questions

    1. Inflammation of subcutaneous fat (panniculitis)
    2. Exocytosis of lymphocytes and spongiotic bulla
    3. Thick collagen bundles with reduced skin appendages
    4. Neutrophilic microabscesses
    5. Vasculitis and perifascicular atrophy
    1. Looking for the underlying cause of the skin changes
    2. Treatment with oral steroids
    3. Excisional biopsy
    4. Treatment with topical steroids
    5. Treatment with antibiotics

    Author of lecture Erythema Nodosum

     Carlo Raj, MD

    Carlo Raj, MD

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