Introduction Erythema nodosum septal panniculitis without vasculitis, characterised by acute episodes of inflammatory and painful subcutaneous nodules affecting, in most cases, the lower extremities. Remission of lesions occurs within 1–6 weeks without scarring or residual atrophy. There are, however, some cases which become chronic or reoccur. In 50% of cases we find an underlying cause. Treatment of acute outbreak involves rest and NSAIDs. The chronic or recurrent cases are treated with oral potassium iodide, cortic osteroids, colchicine, hydroxychloroquine or immunosuppressive agents.
Objectives Description of the cases of refractory chronic erythema nodosum and review of the literature.
Methods Selection of patients with refractory chronic erythema nodosum undergoing treatment with anti TNF in the Rheumatology unit from 2000 to 2010. Literature search using PubMed with keywords erythema nodosum and Adalimumab, Etanercept, Infliximab.
Results See table 1.
Conclusions In our sample, all cases have responded favourably to treatment with anti TNF. No adverse events were observed, except the occurrence of cutaneous psoriasis in one patients after infliximab treatment. In reviewing the literature we find that anti TNF paradoxically brings about an immediate response in erythema nodosum patients, however provokes erythema nodosum and others skin manifestations in patients with either rheumatic pathology or inflammatory bowel disease. [1, 2]
Clayton TH et al, Treatment of chronic erythema nodosum with infliximab. Clin Exp Dermatol. 2006 Nov; 31(6):823–4.
Ortego-Centeno N et al, Refractory chronic erythema nodosum successfully treated with adalimumab. J Eur Acad Dermatol Venereol. 2007 Mar; 21(3):408–10.