Last reviewed: 2 Jul 2021
Last updated: 30 Jul 2021

Summary

Definition

History and exam

Key diagnostic factors

  • presence of risk factors
  • nodules on shins
  • uveitis, red eyes, retinal nodules, or candle-wax drippings
  • nodules on other skin areas
  • anaesthetic skin lesions

Other diagnostic factors

  • joint pains
  • fever
  • diarrhoea, constipation, abdominal pain, haematochezia
  • enlarged spleen
  • miliary nodules on the retina

Risk factors

  • streptococcal infection
  • sarcoidosis
  • tuberculosis
  • coccidioidomycosis
  • histoplasmosis
  • blastomycosis
  • brucellosis
  • Behcet's disease
  • oral contraceptives
  • sulfonamides
  • iodides and anti-epileptic drugs
  • psittacosis
  • leprosy
  • inflammatory bowel disease
  • pregnancy
  • malignancy

Diagnostic investigations

1st investigations to order

  • FBC
  • anti-streptolysin-O titre
  • chest x-ray
  • tuberculin skin test, interferon gamma release assay

Investigations to consider

  • serum ACE level
  • skin lesion biopsy
  • coccidioidin skin test
  • histoplasmin skin test
  • lepromin skin test
  • blastomycosis serology
  • brucellosis serology
  • psittacosis serology
  • x-ray symptomatic joints
  • rheumatoid factor testing
  • Yersinia agglutination titre
  • Yersinia stool cultures
  • colonoscopy
  • serum IgD
  • deep punch biopsies including subcutaneous fat, or incisional biopsies

Treatment algorithm

Contributors

Authors

Daniela Kroshinsky, MD, MPH
Daniela Kroshinsky

Associate Professor of Dermatology

Harvard Medical School

Director of Pediatric Dermatology

Director of Inpatient Dermatology

Massachusetts General Hospital

Boston

MA

Disclosures

DK declares that she has no competing interests.

Acknowledgements

Dr Daniela Kroshinsky would like to gratefully acknowledge Dr Om P. Sharma, a previous contributor to this topic. Dr Kroshinsky would also like to thank Priyanka Vedak for her contribution to this topic. We would like to gratefully acknowledge the contribution of the late Elisabeth Higgins (Consultant Dermatologist, King’s College Hospital) for her peer review of this topic.

Disclosures

OPS declared that he had no competing interests. PV declared that she had no competing interests. EH declared that she had no competing interests.

Peer reviewers

Robert T. Brodell, MD

Professor of Internal Medicine

Clinical Professor of Dermatopathology

Northeastern Ohio Universities College of Medicine

Warren

Associate Clinical Professor of Dermatology

Case Western Reserve University School of Medicine

Cleveland

OH

Disclosures

RTB declares that he has no competing interests.

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