The Etiology of Erythema Nodosum

Abstract

The large number of recent publications on erythema nodosum is a reflection of dissatisfaction with the existing theories of its etiology. The disease occurs chiefly in young children and young adults. The majority of investigations have been carried out on children, but the following observations are based on a study of the disease in thirtyseven adults with an average age of 21 years. The youngest was 18 and the oldest 33. Nineteen of the patients were male and eighteen female, but this equal sex incidence is only apparent, as most of the cases were drawn from the Services. There is no reason to doubt that the disease is commoner in females in the proportion of three to one. In the majority of the cases there was a prodromal stage varying from 3 to 10 days, with malaise and anorexia. The acute stage then began with fever between 99° and 101°F., and a nodose rash appeared on the shins or forearms, or both, 24 to 48 hours later. More than half the patients had coryza or pharyngitis with dry cough. More than half complained of pains in the knees and ankles and the painful joints were usually swollen. Blood counts showed no consistent abnormality, but without exception the erythrocyte sedimentation rate was considerably raised during the febrile stage. Only a few patients had sputum, and this was negative for tubercle bacilli and fungi.