Lesions present as tender, nonulcerated, erythematous nodules located most commonly over the shins, and are sometimes associated with arthralgia and fever.
Lesions occur as a response to a variety of conditions, including infection, chronic inflammatory disease, autoimmune disease, malignancy, and pregnancy. They are also related to the ingestion of certain medications.
Histopathology demonstrates a septal panniculitis without vasculitis. Miescher radial granulomas are a diagnostic feature, but are not necessary for confirmation.
Treatment consists of supportive care, including bed rest and leg elevation, as well as nonsteroidal anti-inflammatory drugs (NSAIDs), potassium iodide, and intralesional or oral corticosteroids. Nodules may also resolve spontaneously. Healing occurs without atrophy or scarring.
Erythema nodosum on the shin of a patient
Personal collection of Dr Om P. Sharma, MD, FRCP, DTM&H
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