Erythema Nodosum Leproticum

The position of erythema nodosum seems to be shared by a good many skin diseases which, despite all attempts, are still dif~ ficult to classify according to their etiology. From the appearance of the lesions and from the course of the disease one feels rather inclined to believe in the probability of its being an infectious disease, though varied in its nature. These features are suggestive enough in the majority of the cases to permit the acceptance of this view as a possibility. That we are not dealing with a uniform etiology, however, is evident. Whether we should accept an idiopathic and a symptomatic erythema nodosum is still an unsettled question. According to many investigators the so-called idiopathic erythema nodosum is a well defined clinical entity, and any deviation from the well known picture should not be designated simply as erythema nodo~ sum but the respective etiological adjective should be added, as in erythema nodosum mycoticum, typhosum, etc. Erythema nodosum idiopathicum is ushered in by constitution~ al disturbances (fever, rheumatoid joint pains) which are' frequently preceded by tonsillitis. This is followed by the appearance of hazelto walnut-sized subcutaneous nodes and nodosities which are symmetrically distributed over the extensor surfaces of the lower extremities, rarely on the upper extremities and extremely rarely on the trunk or the face. These lesions have a faintly outlined, rather edematous border, and are painful to touch. They have no tendency to extend peripherally or to become confluent, and rarely break down. The nodes do not preserve for long their original color, changes taking place in a few days similar to those which are observed in bruises; a bluish, brownish or greenish discoloration is produced, for which reason erythema nodosum is also called erythema contusiforme. After three to four weeks complete recovery takes place, without scar formation.