Erythema Induratum

Erythema Induratum

Article
Skin Care
Diseases & Conditions
+1
Contributed byLester Fahrner, MD+1 moreMar 23, 2021

What are the other Names for this Condition? (Also known as/Synonyms)

  • Erythema Induratum (Nodular Vasculitis)
  • Erythema Induratum, Bazin type
  • Erythema Induratum, Whitfield type

What is Erythema Induratum? (Definition/Background Information)

  • Erythema Induratum (EI), a type of lobular panniculitis, is a benign skin condition that occurs on the calves. The condition is more often observed in young female adults
  • It is generally associated with tuberculosis (TB) of the skin. When Erythema Induratum is present in cutaneous tuberculosis, it is known as Erythema Induratum of Bazin (EIB)
  • However, Erythema Induratum may be of the non-tuberculosis type too; wherein, it is associated with other health conditions. In such cases, it is known as Erythema Induratum, Whitfield type
  • Erythema Induratum manifests as numerous tiny nodules that present pain. Complications may arise from the nodules that include ulceration and bleeding. This can cause scar formation on healing
  • The treatment involves anti-tuberculous therapy, in individuals with cutaneous tuberculosis. In non-tuberculous type (Whitfield type), treatment of the associated (underlying) condition is necessary
  • The prognosis of Erythema Induratum is good in a majority of cases. It is known to resolve once the underlying condition is managed appropriately

Who gets Erythema Induratum? (Age and Sex Distribution)

  • Erythema Induratum (EI) is mostly observed in young adults. However, it may be seen in a wider age group
  • Erythema Induratum, Bazin type is predominantly observed in females, even though males may also be affected. Other forms of EI are seen in both males and females
  • No racial or ethnic group predilection is observed and the condition is observed worldwide

What are the Risk Factors for Erythema Induratum? (Predisposing Factors)

  • Some cases of Erythema Induratum are associated with cutaneous tuberculosis. However, in some individuals, no underlying conditions are noted
  • The Whitfield type can be associated with ulcerative colitis, an inflammatory bowel disorder

It is important to note that having a risk factor does not mean that one will get the condition. A risk factor increases one’s chances of getting a condition compared to an individual without the risk factors. Some risk factors are more important than others.

Also, not having a risk factor does not mean that an individual will not get the condition. It is always important to discuss the effect of risk factors with your healthcare provider.

What are the Causes of Erythema Induratum? (Etiology)

The exact cause of Erythema Induratum is currently unknown. It is a type of nodular vasculitis that is caused by abnormal inflammation of the subcutaneous fat.

  • On a tissue biopsy, the condition shows a pattern of lobular panniculitis, which is a microscopic finding
  • Lobular panniculitis is a condition in which inflammation occurs in the subcutaneous tissue, just beneath the skin. The term ‘panniculitis’ indicates inflammation of fat tissue

There are two main types of Erythema Induratum:

  • Erythema Induratum, Bazin type: When the condition is associated with cutaneous tuberculosis i.e., of tuberculosis origin
  • Erythema Induratum, Whitfield type: When the condition is not associated with cutaneous tuberculosis i.e., of non-tuberculosis origin. In such cases, it may be associated with other disorders or even certain medications

A few forms of Erythema Induratum are idiopathic, meaning that no known cause has been established in them.

What are the Signs and Symptoms of Erythema Induratum?

The signs and symptoms of Erythema Induratum may include:

  • Small painful nodules with redness surrounding them
  • The skin lesions can merge together to form large plaques
  • The nodules can break to form ulcers with bleeding
  • Multiple nodules can occur in the shins; sometimes, they may be observed on the buttocks and arms too
  • Recurrent crops of lesions may be observed
  • Other symptoms of the underlying skin tuberculosis, if present, may be noticed

How is Erythema Induratum Diagnosed?

Erythema Induratum may be diagnosed using the following tools:

  • Complete physical examination with comprehensive evaluation of medical history
  • Tuberculosis skin and blood tests, in case of Erythema Induratum of Bazin
  • Tests and exams to diagnose other underlying causes of Erythema Induratum, if any
  • Dermoscopy: It is a diagnostic tool where a dermatologist examines the skin using a special magnified lens
  • Wood’s lamp examination: In this procedure, the healthcare provider examines the skin using ultraviolet light. It is performed to examine the change in skin pigmentation
  • Skin biopsy: A biopsy is performed and sent to a laboratory for a pathological examination. The pathologist examines the biopsy under a microscope. After putting together clinical findings, special studies on tissues (if needed) and with microscope findings, the pathologist arrives at a definitive diagnosis
  • A differential diagnosis may be performed to rule out conditions that present similar symptoms, such as erythema nodosum, to arrive at a definitive diagnosis

Many clinical conditions may have similar signs and symptoms. Your healthcare provider may perform additional tests to rule out other clinical conditions to arrive at a definitive diagnosis.

What are the possible Complications of Erythema Induratum?

The complications due to Erythema Induratum may include:

  • The nodules may ulcerate and bleed, resulting in the formation of scars on healing
  • Secondary bacterial and fungal infections: The condition may providing a suitable environment for bacteria and fungi to grow and thrive, resulting in secondary infections
  • Cosmetic issues resulting in emotional stress in some individuals
  • Presence of persistent skin lesions
  • Complications may arise from the underlying cutaneous tuberculosis, if present

How is Erythema Induratum Treated?

The treatment of Erythema Induratum (EI) depends on the underlying condition. Treating the underlying condition, such as cutaneous tuberculosis, successfully can result in a cure. In case EI is not associated with a known condition, symptomatic treatment may be provided.

The treatment of Erythema Induratum may involve the following measures:

  • Anti-tuberculous therapy (ATT)
  • Use of systemic steroids to control severity of the condition, if needed. This may be recommended depending on the underlying cause
  • Prescription potassium iodide by mouth
  • Medications, including antibiotics and antifungals, to treat secondary infections (if any)

Follow-up care with regular screening and checkups are important, since the underlying condition may last for many months and years.

How can Erythema Induratum be Prevented?

Currently, there are no known methods to prevent the occurrence of Erythema Induratum. However, one may lower the risk for the skin condition by considering the following factors:

  • Treating any underlying infections/conditions early and adequately
  • Prompt treatment of pulmonary tuberculosis to control spread of the disease to other organs

What is the Prognosis of Erythema Induratum? (Outcomes/Resolutions)

  • The prognosis of Erythema Induratum depends upon the underlying condition and the severity of its signs and symptoms
  • In many individuals with cutaneous tuberculosis, Erythema Induratum is known to resolve completely once the underlying tuberculosis is treated suitably

Additional and Relevant Useful Information for Erythema Induratum:

There are many different types of panniculitis and it has been difficult to obtain an accurate picture of their true incidence, since they may be associated with so many conditions. The different types may include:

  • Lupus panniculitis
  • Erythema nodosum
  • Pancreatitis-associated panniculitis
  • Alpha-1 antitrypsin deficiency associated panniculitis
  • Infective panniculitis
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On the Article

Krish Tangella MD, MBA picture
Approved by

Krish Tangella MD, MBA

Pathology, Medical Editorial Board, DoveMed Team
Lester Fahrner, MD picture
Reviewed by

Lester Fahrner, MD

Chief Medical Officer, DoveMed Team

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