Erythema Nodosum: A Practical Approach and Diagnostic Algorithm

Daniela Michelle Pérez-Garza; Sonia Chavez-Alvarez; Jorge Ocampo-Candiani; Minerva Gomez-Flores


Am J Clin Dermatol. 2021;22(3):367-378. 

In This Article


Panniculitis is a heterogeneous group of inflammatory processes that affect the subcutaneous cellular tissue. They are classified into two groups: (1) lobular or (2) septal panniculitis. Erythema nodosum (EN) is the most common form of panniculitis and it is the prototypic septal panniculitis.[1] Erythema nodosum was first described by Robert Willan in 1798.[2] Historical data concerning EN date back to 1762 to a prior possible description of an EN lesion in a letter from Wolfgang Amadeus, Mozart's father, which could be the first record of this disease.[3] This review aims to evaluate the current literature of the triggering factors and treatment options for EN to propose an easy-to-follow diagnostic algorithm. A search of the literature was performed in PubMed. Keywords used included: "erythema nodosum" and any of the following: "etiology, Behçet's disease, sarcoidosis, tuberculosis, inflammatory bowel disease, streptococcal infection, drugs or vaccines, malignancies or cancer," "epidemiology," "therapy or treatment," "diagnosis," "histopathology," and "pathophysiology." The search was limited to articles published from 1950 to 2020. Titles and abstracts in English and Spanish were reviewed for eligibility. References of selected relevant articles were scanned, and papers from these sources were also included.