Department of Dermatology, Universidad Autonoma de Nuevo Leon, University Hospital "Dr. José Eleuterio González", Avenida Francisco I. Madero y Avenida Gonzalitos S/N, Colonia Mitras Centro, 64460, Monterrey, Nuevo León, Mexico.
Am J Clin Dermatol. 2021 May;22(3):367-378. doi: 10.1007/s40257-021-00592-w. Epub 2021 Mar 8.
Erythema nodosum is the most common form of panniculitis and is characterized by tender erythematous nodules mainly in the lower limbs on the pretibial area. The exact cause of erythema nodosum is unknown, although it appears to be a hypersensitivity response to a variety of antigenic stimuli. Although the etiology is mostly idiopathic, ruling out an underlying disease is imperative before diagnosing primary erythema nodosum. Erythema nodosum can be the first sign of a systemic disease that is triggered by a large group of processes, such as infections, inflammatory diseases, neoplasia, and/or drugs. The most common identifiable causes are streptococcal infections, primary tuberculosis, sarcoidosis, Behçet disease, inflammatory bowel disease, drugs, and pregnancy. We propose a diagnostic algorithm to optimize the initial work-up, hence initiating prompt and accurate management of the underlying disease. The algorithm includes an initial assessment of core symptoms, diagnostic work-up, differential diagnosis, and recommended therapies. Several treatment options for the erythema nodosum lesions have been previously reported; nevertheless, these options treat the symptoms, but not the triggering cause. Making an accurate diagnosis will allow the physician to treat the underlying cause and determine an optimal therapeutic strategy.
结节性红斑是最常见的一种脂膜炎，其特征是小腿前区出现触痛性红斑结节。尽管结节性红斑似乎是对各种抗原刺激的超敏反应，但确切病因尚不清楚。虽然病因大多是特发性的，但在诊断原发性结节性红斑之前，排除潜在疾病是至关重要的。结节性红斑可能是由一大类过程引发的系统性疾病的首发表现，如感染、炎症性疾病、肿瘤和/或药物。最常见的可识别病因是链球菌感染、原发性肺结核、结节病、贝切特病、炎症性肠病、药物和妊娠。我们提出了一种诊断算法来优化初始检查，从而对潜在疾病进行及时准确的治疗。该算法包括对核心症状、诊断检查、鉴别诊断和推荐治疗的初步评估。以前曾报道过几种结节性红斑病变的治疗选择；然而，这些选择仅治疗症状，而不是触发原因。做出准确的诊断将使医生能够治疗潜在病因，并确定最佳的治疗策略。
