Pathogenesis Of Erythema Nodosum Research Articles

Erythema nodosum induced by oral isotretinoin in a patient with condylomata acuminata

Erythema nodosum (EN) is a form of septal panniculitis, which is believed to represent a delayed hypersensitivity reaction activated by infectious agents, drugs, granulomatous and autoimmune diseases, pregnancy, and malignancies. There are only four reported cases of EN during oral isotretinoin therapy to our knowledge, all of them occurring in patients with severe acne. Since acne itself can trigger EN, the question as to whether there is indeed a causative relationship between isotretinoin and EN in the reported cases remains to be elucidated. We present herein a 20-year-old woman with multiple vulvar condylomata acuminata who developed EN two weeks after onset of oral isotretinoin therapy. To the best of our knowledge, this is the first report of EN occurring during isotretinoin treatment in a patient without acne and strongly indicates that the pathogenesis of EN can be directly related to the biological actions of isotretinoin. Erythema nodosum should be regarded as a rare side effect of oral isotretinoin therapy, regardless of the underlying disease. Physicians should be aware of this rare side effect.

Clinical, histopathological, and immunological evaluation of a series of patients with erythema nodosum.

The pathogenesis of erythema nodosum (EN) is still poorly understood, and studies evaluating the involvement of a cytokine network are very scarce. To investigate clinical and pathological features, the cytokine profiles, and the balance of T-regulatory (Treg) and T-helper (Th)17 cells in serum and lesional skin of patients with EN. Patients with a diagnosis of EN were consecutively enrolled, and their clinical and histopathological features were recorded. A panel of cytokines was evaluated in both serum and lesional skin using enzyme-linked immunosorbent assay. Real-time polymerase chain reaction was performed to evaluate the Treg/Th17 cell balance. Histopathological examination of skin biopsy specimens from all patients (four women and one man) showed classical features of EN. The most widely expressed cytokines were innate immunity cytokines (mainly tumor necrosis factor alpha, interleukin-8 and -6) and growth factors (mainly granulocyte colony-stimulating factor and monocyte chemoattractant protein-1). The Treg/Th17 balance was highly different between patients. The present study emphasizes the crucial role of neutrophils in the pathogenesis of EN, as high levels of cytokines and growth factors mainly involved in neutrophil recruitment and activation were detected.

Etiology and Therapeutic Management of Erythema Nodosum During Pregnancy: An Update

Erythema nodosum (EN) is the most common form of panniculitis. It is characterized by erythematous, raised, tender nodules that usually occur bilaterally on the extensor surfaces of the lower extremities. EN is associated with many underlying conditions including infection, sarcoidosis, malignancy, and pregnancy. Its underlying etiology, however, is unknown in up to half of cases. Pregnancy is thought to create an optimal background for EN to develop, although the exact mechanisms are unclear. Immune complexes may play a role in the pathogenesis of EN during pregnancy, or EN may be a hypersensitivity reaction to either estrogens or progesterone. EN is a self-limiting process, and non-pharmacologic means such as bed rest and elastic web bandages may be sufficient to control the symptoms. Potassium iodide, systemic and intralesional corticosteroids, non-steroidal anti-inflammatory drugs, salicylates, tumor necrosis factor-α inhibitors, hydroxychloroquine, colchicine, and dapsone are other treatment options available, but some of these drugs are contraindicated in pregnancy while others are considered safe. Before prescribing one of these treatments to a pregnant patient, the patient's obstetrician should be consulted, and a careful risk-benefit analysis should be performed.

A Case of Erythema Nodosum Associated with Subareolar Abscess

While erythema nodosum is a nodular, erythematous eruption predominantly affecting the extensor aspects of the legs, breast abscesses are the result of relatively common bacterial infections, and only 2 studies have reported an association between erythema nodosum and breast abscesses. Here, we report the case of a patient with repeated erythema nodosum associated with subareolar abscesses. The patient was a 34-year-old woman with painful erythematous nodules on her right shin, accompanied by an indurated lesion on her right breast 4 days before the onset of the nodules. Therefore, the patient underwent circumareolar incision, and consequently the painful erythematous nodules disappeared. However, after 39 days, the patient developed another tender, painful lesion in her right breast and painful erythematous nodules on her right shin. After another circumareolar incision, the painful erythematous nodules disappeared again. Therefore, we suggested a significant association between erythema nodosum and breast abscess in this patient. The most common underlying causative organism in breast abscess is Staphylococcus aureus; however, erythema nodosum has rarely been proven to be associated with staphylococcal infections. Therefore, the relationship between S. aureus and erythema nodosum is rather controversial. However, the resistance to the usual treatment methods and prolonged clinical course in our case suggest that the pathogenesis of erythema nodosum associated with breast abscesses might be different from that of the common form of erythema nodosum.

Erythema nodosum in kidney transplant recipient: a rare complication of pneumonia treatment

Erythema nodosum (EN) is a cutaneous inflammatory reaction, usually reported in young women, but it is rarely observed among transplant patients. Localization in the lower extremities is typical, mostly involving the anterior surfaces of the legs. Several viral, bacterial, mycotic, and non-infectious etiologies, such as autommune disorders, drugs, inflammatory bowel diseases, sarcoidosis, pregnancy, and malignancies, have been found. We describe the case of a young woman kidney transplant recipient developing bilateral, erythematous, warm nodules localized on the anterior surface of her legs after antibiotic treatment for pneumonia with levofloxacin. Her immunosuppression was sirolimus and mycophenolate mofetil. EN was diagnosed by skin biopsy; microscopic examination showed septal panniculitis with granulomas. As a complete remission of the lesions was obtained in our patient after interruption of levofloxacin therapy, we suspect that levofloxacin was involved in the pathogenesis of EN. In fact, the management of EN is based on the treatment of underlying or associated conditions.

Leucocyte activation in erythema nodosum.

As a neutrophilic vascular reaction of small vessels in the subcutaneous tissue and a neutrophilic inflammatory infiltrate are common histopathological features found in initial erythema nodosum (EN) lesions, we asked the question whether activated polymorphonuclear neutrophils (PMN) might play a role in the pathogenesis of EN. We analysed the production of reactive oxygen intermediates (ROI) as a marker for activated neutrophils in the peripheral blood of patients suffering from EN (n = 10) and healthy volunteers (n = 10). FACS analysis of dihydrorhodamine 123-stained PMN was used to detect ROI production due to respiratory burst activity. Patients suffering from EN had a fourfold higher percentage of preactivated ('primed') ROI-producing PMN compared with healthy volunteers. Activation of PMN with formylated methionyl-leucyl-phenylalanine and phorbol 12-myristate 13-acetate led to an increase of ROI production per cell but had no influence on the percentage of activated cells. The percentage of ROI-producing cells in patients with EN correlated with the clinical severity. From these data, we conclude that ROI might play a role in the pathogenesis of EN. ROI might exert their effects by oxidative tissue damage and by promoting tissue inflammation.

Ultrastructure of endothelial cell necrosis in classical erythema nodosum

As evidence of vascular involvement in classical erythema nodosum unassociated with Behçet's disease, the occurrence of endothelial cell necrosis based on the development of dark cell degeneration was observed by electron microscopy in the vasculature of the dermis and subcutaneous fat. The incidence of endothelial cell necrosis in all segments of the microcirculatory system was roughly 20% in three of 12 patients. The remaining nine patients showed a very low rate of necrosis, including two patients in whom endothelial cell necrosis was totally absent. The presence of necrotic endothelial cells that are forced out and eliminated by neighboring intact endothelial cells into the vascular lumen is closely associated with thrombus formation in the cutaneous vasculature. The incidence at which endothelial cell necrosis occurs in classical erythema nodosum is not always high; however, it is concluded that endothelial cell necrosis may play a significant role in the pathogenesis of erythema nodosum.

II. The Pathogenesis of Erythema Nodosum.

Acta Medica ScandinavicaVolume 124, Issue S174 p. 29-35 II. The Pathogenesis of Erythema Nodosum. First published: January/December 1946 https://doi.org/10.1111/j.0954-6820.1946.tb10834.xAboutPDF ToolsRequest permissionExport citationAdd to favoritesTrack citation ShareShare Give accessShare full text accessShare full-text accessPlease review our Terms and Conditions of Use and check box below to share full-text version of article.I have read and accept the Wiley Online Library Terms and Conditions of UseShareable LinkUse the link below to share a full-text version of this article with your friends and colleagues. Learn more.Copy URL Share a linkShare onFacebookTwitterLinked InRedditWechat Volume124, IssueS174January/December 1946Pages 29-35 RelatedInformation

The provocation factor in the pathogenesis of erythema nodosum

The provocation factor in the pathogenesis of erythema nodosum

Pathogenesis of erythema nodosum, with special reference to tuberculosis, streptococcic infection, and rheumatic fever: Spink, Wesley W.: Arch. Int. Med. 59: 65, 1937

Pathogenesis of erythema nodosum, with special reference to tuberculosis, streptococcic infection, and rheumatic fever: Spink, Wesley W.: Arch. Int. Med. 59: 65, 1937