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Erythema nodosum versus nodular vasculitis

M D Sanz Vico1, V De Diego, E Sánchez Yus

  • 1Department of Dermatology, Hospital Universitario San Carlos, Facultad de Medicina, Universidad Complutense, Madrid, Spain.

International Journal of Dermatology
|February 1, 1993
PubMed
Summary

Histopathology accurately distinguishes Erythema nodosum (EN) and nodular vasculitis (NV). This classification is most valuable for atypical or clinically uncertain panniculitis cases, confirming distinct inflammatory patterns.

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Area of Science:

  • Dermatopathology
  • Histopathology
  • Clinical Dermatology

Background:

  • Erythema nodosum (EN) is typically a septal panniculitis.
  • Nodular vasculitis (NV) is generally classified as a lobular panniculitis.
  • Distinguishing EN from NV can be clinically challenging.

Purpose of the Study:

  • To evaluate the diagnostic utility of histopathologic classification in differentiating EN and NV.
  • To assess the clinico-pathologic agreement for EN and NV based on established criteria.

Main Methods:

  • A 3-year study included 109 patients diagnosed with panniculitis.
  • Clinical diagnoses were established using predefined criteria after history and physical examination.
  • Histopathologic analysis was performed on 88 patients.

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Main Results:

  • High clinico-pathologic agreement was observed in typical EN (93%) and NV (94%) cases.
  • Agreement decreased in clinically diagnosed EN migrans (79%), atypical EN (72%), and atypical NV (67%).
  • Septal and lobular panniculitis presented as distinct, opposing patterns of inflammation.

Conclusions:

  • Histopathology serves as the most objective marker for differentiating EN and NV.
  • This is particularly crucial for cases with atypical presentations or diagnostic uncertainty.
  • Histologic patterns clearly distinguish between septal and lobular panniculitis.