Summary
Definition
History and exam
Key diagnostic factors
- presencia de factores de riesgo
- nódulos en las espinillas
- uveítis, ojos rojos, nódulos o gotas de cera de vela en la retina
- nódulos en otras zonas cutáneas
- lesiones cutáneas anestésicas
Other diagnostic factors
- dolores en las articulaciones
- fiebre
- diarrea, estreñimiento, dolor abdominal, hematoquecia
- esplenomegalia
- nódulos miliares en la retina
Risk factors
- infección estreptocócica
- sarcoidosis
- tuberculosis
- coccidioidomicosis
- histoplasmosis
- blastomicosis
- brucelosis
- enfermedad de Behcet
- anticonceptivos orales
- sulfonamidas
- yoduros y fármacos antiepilépticos
- psitacosis
- lepra
- enfermedad inflamatoria intestinal
- embarazo
- neoplasia maligna
Diagnostic investigations
1st investigations to order
- hemograma completo (HC)
- título de antiestreptolisina O
- radiografía de tórax
- prueba cutánea de la tuberculina, ensayo de liberación de interferón gamma
Investigations to consider
- nivel sérico de la enzima convertidora de la angiotensina (ECA)
- lesión cutánea
- prueba cutánea de coccidioidina
- prueba cutánea de histoplasmina
- prueba cutánea de lepromina
- serología para blastomicosis
- serología para brucelosis
- serología para psitacosis
- radiografía de articulaciones sintomáticas
- pruebas de factor reumatoide
- Título de aglutinación para Yersinia
- Coprocultivos de Yersinia
- colonoscopia
- inmunoglobulina D (IgD) sérica
- biopsias profundas en sacabocados que incluyan grasa subcutánea o biopsias por incisión
Treatment algorithm
síntomas leves a moderadamente graves
síntomas graves refractarios
Contributors
Authors
Daniela Kroshinsky, MD, MPH
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.
Peer reviewer acknowledgements
BMJ Best Practice topics are updated on a rolling basis in line with developments in evidence and guidance. The peer reviewers listed here have reviewed the content at least once during the history of the topic.
Disclosures
Peer reviewer affiliations and disclosures pertain to the time of the review.
References
Key articles
Bondi EE, Margolis DJ, Lazarus ZS. Panniculitis. In: Freedberg I, Eisen A, Wolff K, et al, eds. Fitzpatrick's dermatology in general medicine. 5th ed. New York, NY: McGraw-Hill; 1999: 1284-6.
Requena L, Requena C. Erythema nodosum (review). Dermatol Online J. 2002 Jun;8(1):4. Abstract
Sterling JB, Heymann WR. Potassium iodide in dermatology: a 19th century drug for the 21st century-uses, pharmacology, adverse effects, and contraindications. J Am Acad Dermatol. 2000 Oct;43(4):691-7. Abstract
Friedman ES, LaNatra N, Stiller MJ. NSAIDs in dermatologic therapy: review and preview. J Cutan Med Surg. 2002 Sep-Oct;6(5):449-59. Abstract
Schultz E, Whiting D. Treatment of erythema nodosum and nodular vasculitis with potassium iodides. Br J Dermatol. 1976 Jan;94(1):75-8. Abstract
Reference articles
A full list of sources referenced in this topic is available to users with access to all of BMJ Best Practice.
Differentials
- Enfermedad de Weber-Christian
- Deficiencia de alfa-1-antitripsina
- Vasculitis nodular (eritema indurado o enfermedad de Bazin)
More Differentials
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