TAILIEUCHUNG - Chapter 054. Skin Manifestations of Internal Disease (Part 22)

Common causes of erythematous subcutaneous nodules include inflamed epidermoid inclusion cysts, acne cysts, and furuncles. Panniculitis, an inflammation of the fat, also presents as subcutaneous nodules and is frequently a sign of systemic disease. There are several forms of panniculitis, including erythema nodosum, erythema induratum/nodular vasculitis, lupus profundus, lipodermatosclerosis, α1-antitrypsin deficiency, factitial, and fat necrosis secondary to pancreatic disease. Except for erythema nodosum, these lesions may break down and ulcerate or heal with a scar. The shin is the most common location for the nodules of erythema nodosum, whereas the calf is the most common location for lesions of. | Chapter 054. Skin Manifestations of Internal Disease Part 22 Common causes of erythematous subcutaneous nodules include inflamed epidermoid inclusion cysts acne cysts and furuncles. Panniculitis an inflammation of the fat also presents as subcutaneous nodules and is frequently a sign of systemic disease. There are several forms of panniculitis including erythema nodosum erythema induratum nodular vasculitis lupus profundus lipodermatosclerosis a1-antitrypsin deficiency factitial and fat necrosis secondary to pancreatic disease. Except for erythema nodosum these lesions may break down and ulcerate or heal with a scar. The shin is the most common location for the nodules of erythema nodosum whereas the calf is the most common location for lesions of erythema induratum. In erythema nodosum the nodules are initially red but then develop a blue color as they resolve. Patients with erythema nodosum but no underlying systemic illness can still have fever malaise leukocytosis arthralgias and or arthritis. However the possibility of an underlying illness should be excluded and the most common associations are streptococcal infections upper respiratory viral infections sarcoidosis and inflammatory bowel disease in addition to drugs oral contraceptives sulfonamides penicillins bromides iodides . Less common associations include bacterial gastroenteritis Yersinia Salmonella and coccidioidomycosis followed by tuberculosis histoplasmosis brucellosis and infections with Chlamydophila pneumoniae or Chlamydia trachomatis M. pneumoniae or hepatitis B virus. Erythema induratum and nodular vasculitis share a similar histology and were thought to represent the clinical spectrum of a single entity subsequently they have been separated with the latter usually idiopathic and the former associated with the presence of M. tuberculosis DNA by polymerase chain reaction PCR within skin lesions. The lesions of lupus profundus are found primarily on the upper arms and buttocks sites of abundant