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Nodular vasculitis
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Nodular vasculitis

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Contributors: Christine Hunt MD, Belinda Tan MD, PhD, Sylvia Hsu MD
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Synopsis

Erythema induratum, also known as nodular vasculitis, is a form of lobular panniculitis with multiple etiologies. Tender erythematous to violaceous nodules and/or plaques are seen, usually on the calves. Lesions have also been seen on the feet, thighs, buttocks, and arms. Ulceration and drainage may occur. Lesions tend to heal with scarring and are prone to recurrence. Women are most commonly affected (80%-90% of patients), with peaks in incidence during early adolescence and around menopause.

There are many etiologies. Mycobacterium tuberculosis infection is one of the strongest associated triggers. The term erythema induratum of Bazin refers specifically to cases of tuberculous etiology. Cases can also be idiopathic or induced by other infectious agents or drugs. The condition is thought to be either an immune complex-mediated vasculitis or a type IV cell-mediated response to an antigenic stimulus.

Related topic: Cutaneous tuberculosis

Codes

ICD10CM:
L95.8 – Other vasculitis limited to the skin

SNOMEDCT:
55275006 – Nodular vasculitis

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Diagnostic Pearls

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Differential Diagnosis & Pitfalls

  • Erythema nodosum is usually found on the anterior lower legs instead of posterior, is more septal, is usually less granulomatous, and is usually without vasculitis.
  • Other types of infection-induced panniculitis tend to demonstrate more prominent neutrophils. Organisms may be identified with special stains and cultures.
  • Other forms of panniculitis or vasculitis, especially polyarteritis nodosa and thrombophlebitis. In polyarteritis nodosa, leukocytoclastic vasculitis of small- to medium-sized arteries is seen in the deep dermis or subcutaneous fat. Thrombophlebitis involves veins and frequently thrombosis is present. Both polyarteritis nodosa and thrombophlebitis tend to show inflammation limited to the immediate perivascular zone, in contrast to the extensive panniculitis often encountered in erythema induratum / nodular vasculitis.
  • Perniosis, also known as pernio and chilblains, occurs primarily on acral sites with erythematous to violaceous macules, plaques, nodules, or ulcers and is associated with cold exposure. Histologically, perivascular and often peri-eccrine lymphocytes, dermal edema, edema of vessel walls, and sometimes thrombi are seen.

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Last Updated: 12/05/2017
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Nodular vasculitis
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Nodular vasculitis : Erythema, Painful skin lesions, Lower legs, Smooth nodules, Smooth plaques
Clinical image of Nodular vasculitis
A close-up of a pink nodule with surrounding pink erythema on the leg.
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