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Erythema nodosum

January 01, 1970

Erythema nodosum (EN) is an inflammatory condition characterized by inflammation of subcutaneous fat tissue, resulting in painful red/blue lumps or nodules that are usually seen symmetrically on both shins, on the thighs, arms, and elsewhere.[1] It can be caused by a variety of conditions but 20 to 50% of cases are idiopathic. It typically resolves spontaneously within 30 days.[2] It is common in young people aged 12–20 years.

Erythema nodosum
Other namesSubacute migratory panniculitis of Vilanova and Piñol
Erythema nodosum in a person who had recently had streptococcal pharyngitis
SpecialtyDermatology, rheumatology

Signs and symptoms edit

Pre-eruptive phase edit

The first signs of erythema nodosum are often flu-like symptoms such as a fever, cough, malaise, and aching joints. Some people also experience stiffness or swelling in the joints and weight loss.[3]

Eruptive phase edit

Erythema nodosum is characterised by 1–2-inch (25–51 mm) nodules (rounded lumps) below the skin surface, usually on the shins. These subcutaneous nodules can appear anywhere on the body, but the most common sites are the shins, arms, thighs, and torso. Each nodule typically disappears after around two weeks, though new ones may continue to form for up to six or eight weeks.[3] A new nodule usually appears red and is hot and firm to the touch. The redness starts to fade and it gradually becomes softer and smaller until it disappears. Each nodule usually heals completely without scarring over the course of about two weeks.[3][4] Joint pain and inflammation sometimes continue for several weeks or months after the nodules appear.[5]

Less common variants of erythema nodosum include:

  • Ulcerating forms, seen in Crohn's disease
  • Erythema contusiforme, when a subcutaneous hemorrhage (bleeding under the skin) occurs with an erythema nodosum lesion, causing the lesion to look like a contusion (bruise)
  • Erythema nodosum migrans (also known as subacute nodular migratory panniculitis), a rare form of chronic erythema nodosum characterized by asymmetrical nodules that are mildly tender and migrate over time.[6][7][8]
  •  
    Erythema nodosum lesion in a person with light skin and tuberculosis
  •  
    A single lesion of erythema nodosum
  •  
    Several lesions of erythema nodosum in an individual with dark skin

Causes edit

EN is associated with a wide variety of conditions.

Idiopathic edit

About 30–50% of EN cases are idiopathic (of an unknown cause).[9]

Infection edit

Infections associated with EN include:[5]

Autoimmune edit

Autoimmune disorders associated with EN include:[6]

Immune-mediated/Idiopathic granulomatous diseases edit

Pregnancy edit

Pregnancy may be associated with EN.[6]

Medications edit

Medications associated with EN include:[6][9][15]

Cancer edit

Cancers associated with EN include:[6]

EN may also be due to excessive antibody production in lepromatous leprosy leading to deposition of immune complexes.[18]

There is an association with the HLA-B27 histocompatibility antigen, which is present in 65% of patients with erythema nodosum.[19]

A useful mnemonic for causes is SORE SHINS (Streptococci, OCP, Rickettsia, Eponymous (Behçet), Sulfonamides, Hansen's Disease (Leprosy), IBD, NHL, Sarcoidosis.[20]

Pathophysiology edit

Erythema nodosum is probably a delayed hypersensitivity reaction to a variety of antigens. Although circulating immune complexes have been demonstrated in patients with inflammatory bowel disease, they have not been found in idiopathic or uncomplicated cases.[21]

Diagnosis edit

Erythema nodosum is diagnosed clinically. A biopsy can be taken and examined microscopically to confirm an uncertain diagnosis.[4] Microscopic examination usually reveals a neutrophilic infiltrate surrounding capillaries that results in septal thickening, with fibrotic changes in the fat around blood vessels. A characteristic microscopic finding is radial granulomas, well-defined nodular aggregates of histiocytes surrounding a stellate cleft.[5]

Additional evaluation should be performed to determine the underlying cause of erythema nodosum. This may include a full blood count (FBC), erythrocyte sedimentation rate (ESR), antistreptolysin-O (ASO) titer and throat culture, urinalysis, intradermal tuberculin test, and a chest x-ray.[22] The ESR is typically high, the C-reactive protein elevated, and the blood showing an increase in white blood cells.[4]

The ESR is initially very high and falls as the nodules of erythema nodosum. The ASO titer is high in cases associated with a streptococcal throat infection. A chest X-ray should be performed to rule out pulmonary diseases, in particular sarcoidosis and Löfgren syndrome.[4]

Treatment edit

Erythema nodosum is self-limiting and usually resolves itself within 3–6 weeks. A recurring form does exist, and in children, it is attributed to repeated infections with streptococcus.[18] Treatment should focus on the underlying cause. Symptoms can be treated with bed rest, leg elevation, compressive bandages, wet dressings, and nonsteroidal anti-inflammatory agents (NSAIDs).[5] NSAIDs are usually more effective at the onset of EN versus with chronic disease.[23]

Potassium iodide can be used for persistent lesions whose cause remains unknown. Corticosteroids and colchicine can be used in severe refractory cases.[24][25] Thalidomide has been used successfully in the treatment of Erythema nodosum leprosum,[26] and it was approved by the U.S. FDA for this use in July 1998.[27] According to a 2009 meta-analysis, there is some evidence of benefit for both thalidomide and clofazimine in the treatment of erythema nodosum leprosum.[28]

Epidemiology edit

Erythema nodosum is the most common form of panniculitis. It is most common in the ages of 20–30, and affects women 3–6 times more than men.[4]

Eponym edit

The term, Subacute Migratory Panniculitis of Vilanova and Piñol, was named after the two Catalan dermatologists who provided a brief description and explanation of the disease, Xavier Montiu Vilanova (1902–1965) and Joaquin Aguade Piñol (1918–1977), in 1954, and was named in 1956.[29][30]

References edit

  1. ^ "Erythema Nodosum". Johns Hopkins Medicine. Retrieved 12 June 2019.
  2. ^ Pedro-Pons, Agustín (1968). Patología y Clínica Médicas (in Spanish). Vol. 6 (3rd ed.). Barcelona: Salvat. p. 193. ISBN 978-84-345-1106-4.
  3. ^ a b c . Great Ormond Street Hospital for Children NHS Foundation Trust. GOSH NHS Foundation Trust. April 2012. Ref: 2012F1224. Archived from the original on 2017-04-19. Retrieved 2017-04-19.
  4. ^ a b c d e Fitzpatrick, Thomas B. (2005). Fitzpatrick's color atlas and synopsis of clinical dermatology (5th ed.). New York: McGraw-Hill. p. 148. ISBN 978-0-07-144019-6.
  5. ^ a b c d Schwartz, R. A.; Nervi, S. J. (2007). "Erythema nodosum: A sign of systemic disease". American Family Physician. 75 (5): 695–700. PMID 17375516.
  6. ^ a b c d e Gilchrist, Heidi; Patterson, James W. (2010). "Erythema nodosum and erythema induratum (nodular vasculitis): Diagnosis and management". Dermatologic Therapy. 23 (4): 320–7. doi:10.1111/j.1529-8019.2010.01332.x. PMID 20666819. S2CID 39695627.
  7. ^ Rapini, Ronald P.; Bolognia, Jean L.; Jorizzo, Joseph L. (2007). Dermatology: 2-Volume Set. St. Louis: Mosby. ISBN 978-1-4160-2999-1.[page needed]
  8. ^ a b William D. James; Timothy G. Berger; Dirk M. Elston (2011). Andrews' Diseases of the skin : clinical dermatology (11th ed.). [London]: Saunders/ Elsevier. p. 488. ISBN 978-1-4377-0314-6.
  9. ^ a b Mert, Ali; Ozaras, Resat; Tabak, Fehmi; Pekmezci, Salih; Demirkesen, Cuyan; Ozturk, Recep (2009). "Erythema Nodosum: An Experience of 10 Years". Scandinavian Journal of Infectious Diseases. 36 (6–7): 424–7. doi:10.1080/00365540410027184. PMID 15307561. S2CID 13123205.
  10. ^ Laborada, Jennifer; Cohen, Philip R (2021). "Tuberculosis-Associated Erythema Nodosum". Cureus. 13 (12): e20184. doi:10.7759/cureus.20184. PMC 8723782. PMID 35004007.
  11. ^ Renault, Cybèle A.; Ernst, Joel D. (2015). "Mycobacterium leprae (Leprosy)". Mandell, Douglas, and Bennett's Principles and Practice of Infectious Diseases. pp. 2819–2831.e2. doi:10.1016/B978-1-4557-4801-3.00252-6. ISBN 978-1-4557-4801-3.
  12. ^ Budden, Heidi; Ulloa-Gutierrez, Rolando; Dobson, Simon; Scheifele, David (August 2007). "Erythema Nodosum, Mycobacterium avium Lymphadenitis, and a 15-mm Mantoux Test". Pediatric Infectious Disease Journal. 26 (8): 764–765. doi:10.1097/INF.0b013e31807a2fe1. PMID 17848899.
  13. ^ Areias, E; García E Silva, L (1984). "[Erythema nodosum and Crohn's disease]". Medicina Cutanea Ibero-latino-americana. 12 (6): 489–95. PMID 6152299.
  14. ^ Katta, Rajani (15 April 2002). "Cutaneous sarcoidosis: a dermatologic masquerader". American Family Physician. 65 (8): 1581–1584. PMID 11989634.
  15. ^ Bohn, S; Büchner, S; Itin, P (1997). "Erythema nodosum: 112 cases. Epidemiology, clinical aspects and histopathology". Schweizerische Medizinische Wochenschrift. 127 (27–28): 1168–76. PMID 9324739.
  16. ^ Schwartz, Robert A.; Nervi, Stephen J. (2007-03-01). "Erythema nodosum: a sign of systemic disease". American Family Physician. 75 (5): 695–700. ISSN 0002-838X. PMID 17375516.
  17. ^ Rogerson, S J; Nye, F J (1990). "Hepatitis B vaccine associated with erythema nodosum and polyarthritis". BMJ. 301 (6747): 345. doi:10.1136/bmj.301.6747.345. PMC 1663612. PMID 2144199.
  18. ^ a b Kumar, Vinay; Abbas, Abul K.; Fausto, Nelson; Aster, Jon C. (2009). Robbins and Coltran Pathological Basis of Disease. Saunders/Elsevier. pp. 372–3. ISBN 978-1-4160-4930-2.
  19. ^ Cunha, Burke A. (1999). Infectious disease pearls. Philadelphia: Hanley & Belfus. p. 105. ISBN 978-1-56053-203-3.
  20. ^ Wigley, J.; Shantikumar, S. (2014). "Practice Paper 4: Answers §Crohn's disease". Get Ahead! SURGERY 100 EMQs for Finals (2nd ed.). Taylor & Francis. p. 151. ISBN 9781444181807. OCLC 893164082.
  21. ^ Nguyen, Geoffrey C.; Torres, Esther A.; Regueiro, Miguel; Bromfield, Gillian; Bitton, Alain; Stempak, Joanne; Dassopoulos, Themistocles; Schumm, Philip; Gregory, Federico J.; Griffiths, Anne M.; Hanauer, Stephen B.; Hanson, Jennifer; Harris, Mary L.; Kane, Sunanda V.; Orkwis, Heather Kiraly; Lahaie, Raymond; Oliva-Hemker, Maria; Pare, Pierre; Wild, Gary E.; Rioux, John D.; Yang, Huiying; Duerr, Richard H.; Cho, Judy H.; Steinhart, A. Hillary; Brant, Steven R.; Silverberg, Mark S. (2006). "Inflammatory Bowel Disease Characteristics Among African Americans, Hispanics, and Non-Hispanic Whites: Characterization of a Large North American Cohort". The American Journal of Gastroenterology. 101 (5): 1012–23. doi:10.1111/j.1572-0241.2006.00504.x. PMID 16696785. S2CID 7720460.
  22. ^ García-Porrúa, Carlos; González-Gay, Miguel A.; Vázquez-Caruncho, Manuel; López-Lazaro, Luis; Lueiro, Mercedes; Fernández, Maria L.; Alvarez-Ferreira, Javier; Pujol, Ramón M. (2000). "Erythema nodosum: Etiologic and predictive factors in a defined population". Arthritis & Rheumatism. 43 (3): 584–92. doi:10.1002/1529-0131(200003)43:3<584::AID-ANR15>3.0.CO;2-6. PMID 10728752.
  23. ^ "Erythema Nodosum". The Lecturio Medical Concept Library. 24 July 2020. Retrieved 21 July 2021.
  24. ^ Mat, C.; Yurdakul, S; Uysal, S; Gogus, F; Ozyazgan, Y; Uysal, O; Fresko, I; Yazici, H (2005). "A double-blind trial of depot corticosteroids in Behcet's syndrome". Rheumatology. 45 (3): 348–52. doi:10.1093/rheumatology/kei165. PMID 16263779.
  25. ^ Yurdakul, Sebahattin; Mat, Cem; Tüzün, Yalçin; Özyazgan, Yilmaz; Hamuryudan, Vedat; Uysal, Ömer; Şenocak, Mustafa; Yazici, Hasan (2001). "A double-blind trial of colchicine in Behçet's syndrome". Arthritis & Rheumatism. 44 (11): 2686–92. doi:10.1002/1529-0131(200111)44:11<2686::AID-ART448>3.0.CO;2-H. PMID 11710724. S2CID 19523919.
  26. ^ Silverman, W. A. (2002). "The Schizophrenic Career of a 'Monster Drug'". Pediatrics. 110 (2): 404–6. doi:10.1542/peds.110.2.404. PMID 12165600.
  27. ^ Rouhi, Maureen (20 June 2005). "THALIDOMIDE". Chemical & Engineering News Archive. 83 (25): 122. doi:10.1021/cen-v083n025.p122.
  28. ^ Van Veen, Natasja HJ; Lockwood, Diana NJ; van Brakel, Wim H; Ramirez Jr, Jose; Richardus, Jan Hendrik (8 July 2009). "Interventions for erythema nodosum leprosum". Cochrane Database of Systematic Reviews (3): CD006949. doi:10.1002/14651858.CD006949.pub2. PMID 19588412.
  29. ^ Subacute Nodular Migratory Panniculitis (Vilanova Disease) at eMedicine
  30. ^ Mascaró, J. M. (1978). "In memoriam Joaquin Piñol Aguadé, 1918--1977". Der Hautarzt; Zeitschrift für Dermatologie, Venerologie, und Verwandte Gebiete. 29 (11): 613–4. PMID 363649.

External links edit

 
Wikimedia Commons has media related to Erythema nodosum.

January 01, 1970
erythema, nodosum, inflammatory, condition, characterized, inflammation, subcutaneous, tissue, resulting, painful, blue, lumps, nodules, that, usually, seen, symmetrically, both, shins, thighs, arms, elsewhere, caused, variety, conditions, cases, idiopathic, t. Erythema nodosum EN is an inflammatory condition characterized by inflammation of subcutaneous fat tissue resulting in painful red blue lumps or nodules that are usually seen symmetrically on both shins on the thighs arms and elsewhere 1 It can be caused by a variety of conditions but 20 to 50 of cases are idiopathic It typically resolves spontaneously within 30 days 2 It is common in young people aged 12 20 years Erythema nodosumOther namesSubacute migratory panniculitis of Vilanova and PinolErythema nodosum in a person who had recently had streptococcal pharyngitisSpecialtyDermatology rheumatology Contents 1 Signs and symptoms 1 1 Pre eruptive phase 1 2 Eruptive phase 2 Causes 2 1 Idiopathic 2 2 Infection 2 3 Autoimmune 2 4 Immune mediated Idiopathic granulomatous diseases 2 5 Pregnancy 2 6 Medications 2 7 Cancer 3 Pathophysiology 4 Diagnosis 5 Treatment 6 Epidemiology 7 Eponym 8 References 9 External linksSigns and symptoms editPre eruptive phase edit The first signs of erythema nodosum are often flu like symptoms such as a fever cough malaise and aching joints Some people also experience stiffness or swelling in the joints and weight loss 3 Eruptive phase edit Erythema nodosum is characterised by 1 2 inch 25 51 mm nodules rounded lumps below the skin surface usually on the shins These subcutaneous nodules can appear anywhere on the body but the most common sites are the shins arms thighs and torso Each nodule typically disappears after around two weeks though new ones may continue to form for up to six or eight weeks 3 A new nodule usually appears red and is hot and firm to the touch The redness starts to fade and it gradually becomes softer and smaller until it disappears Each nodule usually heals completely without scarring over the course of about two weeks 3 4 Joint pain and inflammation sometimes continue for several weeks or months after the nodules appear 5 Less common variants of erythema nodosum include Ulcerating forms seen in Crohn s disease Erythema contusiforme when a subcutaneous hemorrhage bleeding under the skin occurs with an erythema nodosum lesion causing the lesion to look like a contusion bruise Erythema nodosum migrans also known as subacute nodular migratory panniculitis a rare form of chronic erythema nodosum characterized by asymmetrical nodules that are mildly tender and migrate over time 6 7 8 nbsp Erythema nodosum lesion in a person with light skin and tuberculosis nbsp A single lesion of erythema nodosum nbsp Several lesions of erythema nodosum in an individual with dark skinCauses editEN is associated with a wide variety of conditions Idiopathic edit About 30 50 of EN cases are idiopathic of an unknown cause 9 Infection edit Infections associated with EN include 5 Streptococcal infection which in children is by far the most common precipitant 8 Several granulomatous mycobacterial infections including tuberculosis 10 leprosy 11 and M avium complex 12 Mycoplasma pneumoniae Histoplasma capsulatum Yersinia Lymphogranuloma venereum LGV caused by the bacteria Chlamydia trachomatis Epstein Barr virus Coccidioides immitis Valley fever Cat scratch disease Autoimmune edit Autoimmune disorders associated with EN include 6 Behcet s disease Immune mediated Idiopathic granulomatous diseases edit Crohn s disease 13 Sarcoidosis 14 Pregnancy edit Pregnancy may be associated with EN 6 Medications edit Medications associated with EN include 6 9 15 Omeprazole Sulfonamides Oral contraceptives 16 Penicillins Bromides Hepatitis B vaccination 17 Cancer edit Cancers associated with EN include 6 Non Hodgkin s lymphoma NHL Carcinoid tumours Pancreatic cancer EN may also be due to excessive antibody production in lepromatous leprosy leading to deposition of immune complexes 18 There is an association with the HLA B27 histocompatibility antigen which is present in 65 of patients with erythema nodosum 19 A useful mnemonic for causes is SORE SHINS Streptococci OCP Rickettsia Eponymous Behcet Sulfonamides Hansen s Disease Leprosy IBD NHL Sarcoidosis 20 Pathophysiology editErythema nodosum is probably a delayed hypersensitivity reaction to a variety of antigens Although circulating immune complexes have been demonstrated in patients with inflammatory bowel disease they have not been found in idiopathic or uncomplicated cases 21 Diagnosis editErythema nodosum is diagnosed clinically A biopsy can be taken and examined microscopically to confirm an uncertain diagnosis 4 Microscopic examination usually reveals a neutrophilic infiltrate surrounding capillaries that results in septal thickening with fibrotic changes in the fat around blood vessels A characteristic microscopic finding is radial granulomas well defined nodular aggregates of histiocytes surrounding a stellate cleft 5 Additional evaluation should be performed to determine the underlying cause of erythema nodosum This may include a full blood count FBC erythrocyte sedimentation rate ESR antistreptolysin O ASO titer and throat culture urinalysis intradermal tuberculin test and a chest x ray 22 The ESR is typically high the C reactive protein elevated and the blood showing an increase in white blood cells 4 The ESR is initially very high and falls as the nodules of erythema nodosum The ASO titer is high in cases associated with a streptococcal throat infection A chest X ray should be performed to rule out pulmonary diseases in particular sarcoidosis and Lofgren syndrome 4 Treatment editErythema nodosum is self limiting and usually resolves itself within 3 6 weeks A recurring form does exist and in children it is attributed to repeated infections with streptococcus 18 Treatment should focus on the underlying cause Symptoms can be treated with bed rest leg elevation compressive bandages wet dressings and nonsteroidal anti inflammatory agents NSAIDs 5 NSAIDs are usually more effective at the onset of EN versus with chronic disease 23 Potassium iodide can be used for persistent lesions whose cause remains unknown Corticosteroids and colchicine can be used in severe refractory cases 24 25 Thalidomide has been used successfully in the treatment of Erythema nodosum leprosum 26 and it was approved by the U S FDA for this use in July 1998 27 According to a 2009 meta analysis there is some evidence of benefit for both thalidomide and clofazimine in the treatment of erythema nodosum leprosum 28 Epidemiology editErythema nodosum is the most common form of panniculitis It is most common in the ages of 20 30 and affects women 3 6 times more than men 4 Eponym editThe term Subacute Migratory Panniculitis of Vilanova and Pinol was named after the two Catalan dermatologists who provided a brief description and explanation of the disease Xavier Montiu Vilanova 1902 1965 and Joaquin Aguade Pinol 1918 1977 in 1954 and was named in 1956 29 30 References edit Erythema Nodosum Johns Hopkins Medicine Retrieved 12 June 2019 Pedro Pons Agustin 1968 Patologia y Clinica Medicas in Spanish Vol 6 3rd ed Barcelona Salvat p 193 ISBN 978 84 345 1106 4 a b c Information for Families Erythema nodosum Great Ormond Street Hospital for Children NHS Foundation Trust GOSH NHS Foundation Trust April 2012 Ref 2012F1224 Archived from the original on 2017 04 19 Retrieved 2017 04 19 a b c d e Fitzpatrick Thomas B 2005 Fitzpatrick s color atlas and synopsis of clinical dermatology 5th ed New York McGraw Hill p 148 ISBN 978 0 07 144019 6 a b c d Schwartz R A Nervi S J 2007 Erythema nodosum A sign of systemic disease American Family Physician 75 5 695 700 PMID 17375516 a b c d e Gilchrist Heidi Patterson James W 2010 Erythema nodosum and erythema induratum nodular vasculitis Diagnosis and management Dermatologic Therapy 23 4 320 7 doi 10 1111 j 1529 8019 2010 01332 x PMID 20666819 S2CID 39695627 Rapini Ronald P Bolognia Jean L Jorizzo Joseph L 2007 Dermatology 2 Volume Set St Louis Mosby ISBN 978 1 4160 2999 1 page needed a b William D James Timothy G Berger Dirk M Elston 2011 Andrews Diseases of the skin clinical dermatology 11th ed London Saunders Elsevier p 488 ISBN 978 1 4377 0314 6 a b Mert Ali Ozaras Resat Tabak Fehmi Pekmezci Salih Demirkesen Cuyan Ozturk Recep 2009 Erythema Nodosum An Experience of 10 Years Scandinavian Journal of Infectious Diseases 36 6 7 424 7 doi 10 1080 00365540410027184 PMID 15307561 S2CID 13123205 Laborada Jennifer Cohen Philip R 2021 Tuberculosis Associated Erythema Nodosum Cureus 13 12 e20184 doi 10 7759 cureus 20184 PMC 8723782 PMID 35004007 Renault Cybele A Ernst Joel D 2015 Mycobacterium leprae Leprosy Mandell Douglas and Bennett s Principles and Practice of Infectious Diseases pp 2819 2831 e2 doi 10 1016 B978 1 4557 4801 3 00252 6 ISBN 978 1 4557 4801 3 Budden Heidi Ulloa Gutierrez Rolando Dobson Simon Scheifele David August 2007 Erythema Nodosum Mycobacterium avium Lymphadenitis and a 15 mm Mantoux Test Pediatric Infectious Disease Journal 26 8 764 765 doi 10 1097 INF 0b013e31807a2fe1 PMID 17848899 Areias E Garcia E Silva L 1984 Erythema nodosum and Crohn s disease Medicina Cutanea Ibero latino americana 12 6 489 95 PMID 6152299 Katta Rajani 15 April 2002 Cutaneous sarcoidosis a dermatologic masquerader American Family Physician 65 8 1581 1584 PMID 11989634 Bohn S Buchner S Itin P 1997 Erythema nodosum 112 cases Epidemiology clinical aspects and histopathology Schweizerische Medizinische Wochenschrift 127 27 28 1168 76 PMID 9324739 Schwartz Robert A Nervi Stephen J 2007 03 01 Erythema nodosum a sign of systemic disease American Family Physician 75 5 695 700 ISSN 0002 838X PMID 17375516 Rogerson S J Nye F J 1990 Hepatitis B vaccine associated with erythema nodosum and polyarthritis BMJ 301 6747 345 doi 10 1136 bmj 301 6747 345 PMC 1663612 PMID 2144199 a b Kumar Vinay Abbas Abul K Fausto Nelson Aster Jon C 2009 Robbins and Coltran Pathological Basis of Disease Saunders Elsevier pp 372 3 ISBN 978 1 4160 4930 2 Cunha Burke A 1999 Infectious disease pearls Philadelphia Hanley amp Belfus p 105 ISBN 978 1 56053 203 3 Wigley J Shantikumar S 2014 Practice Paper 4 Answers Crohn s disease Get Ahead SURGERY 100 EMQs for Finals 2nd ed Taylor amp Francis p 151 ISBN 9781444181807 OCLC 893164082 Nguyen Geoffrey C Torres Esther A Regueiro Miguel Bromfield Gillian Bitton Alain Stempak Joanne Dassopoulos Themistocles Schumm Philip Gregory Federico J Griffiths Anne M Hanauer Stephen B Hanson Jennifer Harris Mary L Kane Sunanda V Orkwis Heather Kiraly Lahaie Raymond Oliva Hemker Maria Pare Pierre Wild Gary E Rioux John D Yang Huiying Duerr Richard H Cho Judy H Steinhart A Hillary Brant Steven R Silverberg Mark S 2006 Inflammatory Bowel Disease Characteristics Among African Americans Hispanics and Non Hispanic Whites Characterization of a Large North American Cohort The American Journal of Gastroenterology 101 5 1012 23 doi 10 1111 j 1572 0241 2006 00504 x PMID 16696785 S2CID 7720460 Garcia Porrua Carlos Gonzalez Gay Miguel A Vazquez Caruncho Manuel Lopez Lazaro Luis Lueiro Mercedes Fernandez Maria L Alvarez Ferreira Javier Pujol Ramon M 2000 Erythema nodosum Etiologic and predictive factors in a defined population Arthritis amp Rheumatism 43 3 584 92 doi 10 1002 1529 0131 200003 43 3 lt 584 AID ANR15 gt 3 0 CO 2 6 PMID 10728752 Erythema Nodosum The Lecturio Medical Concept Library 24 July 2020 Retrieved 21 July 2021 Mat C Yurdakul S Uysal S Gogus F Ozyazgan Y Uysal O Fresko I Yazici H 2005 A double blind trial of depot corticosteroids in Behcet s syndrome Rheumatology 45 3 348 52 doi 10 1093 rheumatology kei165 PMID 16263779 Yurdakul Sebahattin Mat Cem Tuzun Yalcin Ozyazgan Yilmaz Hamuryudan Vedat Uysal Omer Senocak Mustafa Yazici Hasan 2001 A double blind trial of colchicine in Behcet s syndrome Arthritis amp Rheumatism 44 11 2686 92 doi 10 1002 1529 0131 200111 44 11 lt 2686 AID ART448 gt 3 0 CO 2 H PMID 11710724 S2CID 19523919 Silverman W A 2002 The Schizophrenic Career of a Monster Drug Pediatrics 110 2 404 6 doi 10 1542 peds 110 2 404 PMID 12165600 Rouhi Maureen 20 June 2005 THALIDOMIDE Chemical amp Engineering News Archive 83 25 122 doi 10 1021 cen v083n025 p122 Van Veen Natasja HJ Lockwood Diana NJ van Brakel Wim H Ramirez Jr Jose Richardus Jan Hendrik 8 July 2009 Interventions for erythema nodosum leprosum Cochrane Database of Systematic Reviews 3 CD006949 doi 10 1002 14651858 CD006949 pub2 PMID 19588412 Subacute Nodular Migratory Panniculitis Vilanova Disease at eMedicine Mascaro J M 1978 In memoriam Joaquin Pinol Aguade 1918 1977 Der Hautarzt Zeitschrift fur Dermatologie Venerologie und Verwandte Gebiete 29 11 613 4 PMID 363649 External links edit nbsp Wikimedia Commons has media related to Erythema nodosum Retrieved from https en wikipedia org w index php title Erythema nodosum amp oldid 1225741566, wikipedia, wiki, book, books, library,

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