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aka Erythema Contusiformis (a very appropriate descriptive name because the lesions often take on the look of a deep bruise)
| • | mnemonic: e. nodosum is almost the “opposite” of nodular vasculitis (septal without vasculitis without ulceration vs. lobular with vasculitis with ulceration) |
Etiology: (think of two in each category)
| • | Infection: beta-hemolytic strep pharyngitis (usually within 3 weeks of infection; increased ASO); TB (associated with primary infection) |
| • | Drugs: sulfonamides; oral contraceptives (pregnancy also) |
| • | Inflammatory: Sarcoidosis: (Löfgrens syndrome); Inflammatory Bowel Disease: ulcerative colitis especially (often correlates with disease activity) |
clinical:
| • | new lesions often accompanied by fever, chills, malaise and leukocytosis |
| • | never ulcerate (vs. nodular vasculitis) |
| • | resolve spontaneously within 3-6 weeks |
Erythema Nodosum Migrans:
| • | clinical variant (AKA Vilanova variant) |
| • | as lesion progresses, may assume arciform pattern with brightly erythematous edge |
Treatment:
| • | NSAIDS, SSKI, ILK, PO steroids |
| • | SSKI - second line for me: hard to find in the pharmacy (usually needs to be ordered); patients don't like taking it (taste, frequency etc...) and I have not found it to be particularly effective |
| • | I usually start with Naproxen 250mg PO BID |
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