Clinical features
A prodrome of weight loss, malaise, low-grade fever, cough, and arthralgia with or without arthritis may be seen one to three weeks before the onset of the disease (1,2)
Characteristically the lesions are:
- painful, palpable, dusky blue nodules or plaques:
- may vary from 1-10 cm in diameter
- poorly demarcated
- most commonly on the shins and calves
- may spread to the thighs and extensor surfaces of the forearm and the trunk
- tend to be symmetrical
- initially the nodules are firm but becomes more fluctuant as the disease progress
- lesions resolve completely over 1-2 months and may produce to produce an appearance similar to bruising as they fade
- ulceration of the nodules cannot be seen and usually heal without atrophy or scarring
- there may be the appearance of new lesions as the old ones resolve
Arthralgia produced during the prodrome period has been known to continue for up to 2 years after the resolution of the disease and may cause nonspecific destructive changes in the joint.
References:
- Requena L, Requena C. Erythema nodosum (review). Dermatol Online J. 2002 Jun;8(1):4.
- Perez-Garza D et al. Erythema Nodosum: A Practical Approach and Diagnostic Algorithm. Am J Clin Dermatol. 2021 May;22(3):367-378
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