Adverse drug reactions on the skin
Robert A. Norman in Geriatric Dermatology, 2020
Erythema nodosum is a cutaneous reaction pattern characterized by erythematous, tender or painful subcutaneous nodules commonly distributed over the anterior aspect of the lower legs, and occasionally elsewhere. More common in young women, erythema nodosum is often associated with increased estrogen levels such as occur during pregnancy and with the ingestion of oral contraceptives. It is also an occasional manifestation of streptococcal infection, sarcoidosis, secondary syphilis, tuberculosis, certain deep fungal infections, Hodgkin’s disease, leukemia, ulcerative colitis and radiation therapy and is often preceded by fever, fatigue, arthralgia, vomiting and diarrhea. The incidence of erythema nodosum due to drugs is low and it is impossible to distinguish clinically between erythema nodosum due to drugs and that caused by other factors.
Erythema Nodosum
K. Gupta, P. Carmichael, A. Zumla in 100 Short Cases for the MRCP, 2020
Erythema nodosum is typically characterized by the presence of painful, subcutaneous, bilateral erythematous nodules over the pretibial areas. The lesions appear as dusky, red and tender nodules. The extensor surface of the upper limbs can also be involved. Women are affected more commonly than men (3:1). Fever and arthralgia (most commonly ankle joints) are common. There are several known causes (see list above), although in up to 50% of cases the cause may remain unknown. The condition is thought to be a hypersensitivity vasculitis (type III mediated immune complex). Biopsy of the nodules reveals panniculitis affecting the subcutaneous connective tissues. In most cases patients recover between 4-6 weeks without any residual scarring or joint damage. Ecchymotic bruised appearance may last for several weeks. In some cases the skin lesions may be recurrent.
Lower legs
Richard Ashton, Barbara Leppard in Differential Diagnosis in Dermatology, 2021
Common causes of erythema nodosum: Drugs, e.g. sulphonamides and the oral contraceptive pill.Pregnancy.Streptococcal sore throat.Sarcoidosis.Ulcerative colitis.Crohn's disease.Tuberculosis.Numerous other viral, bacterial and fungal infections.
The ocular involvement did not accompany with the genital ulcer or the gastrointestinal symptoms at the early stage of Behçet’s disease
Published in Modern Rheumatology, 2019
Akiko Suwa, Nobuyuki Horita, Takehito Ishido, Masaki Takeuchi, Tatsukata Kawagoe, Etsuko Shibuya, Takahiro Yamane, Takahiko Hayashi, Akira Meguro, Mizuho Ishido, Kaoru Minegishi, Ryusuke Yoshimi, Yohei Kirino, Shingo Kato, Jun Arimoto, Takeshi Fukumoto, Yoshiaki Ishigatsubo, Michiko Kurosawa, Takeshi Kaneko, Mitsuhiro Takeno, Nobuhisa Mizuki
Oral ulceration was diagnosed based on recurrent well-defined shallow aphthous oral ulcers that may appear on oral mucosa including labial mucosa, buccal mucosa, tongue, and gingiva. Skin lesions were diagnosed based on erythema nodosum typically appearing in the lower limbs; hypocutaneous thrombophlebitis; folliculitis and acne typically appearing on the face, neck, and back. Ocular lesions were diagnosed based on bilateral uveitis with episodic attack of conjunctival congestion, ophthalmalgia, decreased visual acuity, and visual field deficit. Genital ulceration was diagnosed based on well-defined painful aphthous ulcer typically appearing on the scrotum and penis of a male and the labia major and labia minor of a female. More detailed description of each manifestation is available elsewhere [21].
Oncoplastic Breast Surgery Techniques When Surgery is Essential for the Management of the Idiopatic Granulomatous Mastitis
Published in Journal of Investigative Surgery, 2022
Ahmet Dağ, Akay Edizsoy, Mustafa Berkeşoğlu
Between 2016 and 2020, 20 female patients diagnosed with IGM underwent surgery. Of these 20 patients, 18 patients who underwent wide excision with OBS techniques were included in the study. Two patients who benefited from debridement and abscess drainage were excluded from the study. All patients were of reproductive age and the average age of these patients was approximately 34.2 years (range: 25–42 years). All patients had a history of at least one delivery, with an average of 2.1 (1–4). Fifteen patients had breastfed for an average of 16 months (range: 3–36 months). Three patients had problems with breastfeeding because of nipple problems, and two patients could breastfeed only for 3 months. Four patients (22.2%) had a history of OCU of at least 6 months. Nine patients (50%) were smokers, and two patients (11.1%) had a history of diabetes mellitus. None of the patients had a history of tuberculosis. Only two patients had a family history of tuberculosis. Two patients (11.1%) had a history of erythema nodosum. Rheumatologic tests were negative, and prolactin levels were normal in all the patients. Tissue culture, ARB, and PCR examinations of the patients also showed no signs of tuberculosis. Two patients (11.1%) were diagnosed with FNAB; 14 (77.8%) with ultrasound-guided tru-cut; and two (11.1%) with abscess drainage. Two patients had a history of excision. Steroids were prescribed to 15 patients for at least 8 weeks (mean 11.5 weeks) after the diagnosis of GM. Three of these patients (16.7%) received methotrexate treatment because of steroid-related side effects (Tables 1 and 2).
Clinical phenotypes of Behçet’s syndrome in a large cohort of Italian patients: focus on gender differences
Published in Scandinavian Journal of Rheumatology, 2021
P Leccese, MC Padula, N Lascaro, AA Padula, S D’Angelo
Our results on clinical manifestations are summarized in Table 1. Mucocutaneous involvement was the most common manifestation, followed by ocular lesions, fever, and arthralgia. According to ISG criteria, all patients included in the study had oral aphthosis. Although the difference was not statistically significant, genital ulcers were a more frequent manifestation in females (65.0% in females vs 56.6% in males). The frequency of folliculitis was slightly higher in males (19.1%) than in females (15.4%), while a comparable frequency was found for pathergy (7.1% vs 6.8%, respectively). Statistically significant gender-related differences were recognized for papulopustolar lesions, which were more frequent in males (p < 0.01, OR 5.83). Erythema nodosum was more frequent in females than in males (p < 0.01, OR 0.48).
Related Knowledge Centers
- Inflammation
- Panniculitis
- Malaise
- Nodule
- Subcutaneous Tissue
- Crohn's Disease
- Bleeding
- Bruise
- Idiopathic Disease
- Streptococcus