eMedicine Specialties > Dermatology > Diseases of the Subcutaneous Tissue

Subacute Nodular Migratory Panniculitis (Vilanova Disease)

Author: Sarah M Sawyer, MD, Staff Physician, Department of Dermatology, University of Alabama School of Medicine
Coauthor(s): Daniel Davis, MD, Associate Professor, Departments of Dermatology, Otolaryngology, and Pathology, University of Arkansas for Medical Sciences; Vlada Groysman, MD, Staff Physician, Department of Dermatology, University of Alabama School of Medicine
Contributor Information and Disclosures

Updated: Mar 19, 2009

Introduction

Background

Vilanova disease, or subacute nodular migratory panniculitis, was first observed in 19541 and then named by Vilanova and Pinol Aguade in 1956.2 Vilanova's original 14 patients were all women, most of whom were in their fifth decade of life. Since then, this condition has been diagnosed in men and women.

The nomenclature of this and related diseases is confusing, and some authors believe that Vilanova disease is merely a version of erythema nodosum because the histology is the same. The term chronic erythema nodosum is often used interchangeably with subacute nodular migratory panniculitis.3,4

Pathophysiology

This is a disease of the subcutaneous septa and the blood vessels in the legs. This type of panniculitis exhibits greater septal thickening, granulomatous infiltration of the septa, and an absence of phlebitis. Although alpha1-antitrypsin deficiency, infectious etiology (streptococcal infection), and thyroid disease have been suggested, no specific etiologic agent has been found.

Frequency

United States

Because of the ambiguity of this diagnosis versus other closely related conditions, no frequency has been determined.

Mortality/Morbidity

This condition has resulted in no mortality. It responds well to treatment, but recurrences are possible.

Race

No racial predilection is apparent.

Sex

It is more common in women than in men.5

Age

Vilanova disease has most frequently been reported in the third to sixth decades of life.

Clinical

History

  • Most commonly, patients describe a painless red nodule on the anterolateral aspect of the lower extremities that enlarges via centrifugal expansion or by the confluence of other nodules in proximity. Some nodules may exhibit central clearing with a morpheaform appearance. Usually, no trauma to the affected area is reported.
  • Some patients describe concurrent sore throat, fever, or arthralgias.

Physical

  • The examination typically reveals a unilateral, single, discrete, erythematous nodule or plaque on the anterolateral part of a lower extremity.
  • The lesion displays peripheral extension, and the central portion may have a yellowish hue later in the course.
  • A characteristic lack of ulceration of these lesions is noted.
  • Over weeks or months, the nodules migrate (hence the name) and can become crescentic in nature.

Causes

  • Although this disease has been likened to erythema nodosum, the typical causative agents for classic erythema nodosum are not applicable to Vilanova disease. No obvious cause is apparent, but some reports document streptococcal infection in some patients.6

More on Subacute Nodular Migratory Panniculitis (Vilanova Disease)

Overview: Subacute Nodular Migratory Panniculitis (Vilanova Disease)
Differential Diagnoses & Workup: Subacute Nodular Migratory Panniculitis (Vilanova Disease)
Treatment & Medication: Subacute Nodular Migratory Panniculitis (Vilanova Disease)
Follow-up: Subacute Nodular Migratory Panniculitis (Vilanova Disease)
References
[ CLOSE WINDOW ]

References

  1. Bafverstedt B. Not Available. Acta Derm Venereol. 1954;34(3):181-93. [Medline].

  2. Vilanova X, Pinol Aguade J. Subacute Nodular Migratory Panniculitis. Br J Dermatol. Feb 1959;71(2):45-50. [Medline].

  3. de Almeida Prestes C, Winkelmann RK, Su WP. Septal granulomatous panniculitis: comparison of the pathology of erythema nodosum migrans (migratory panniculitis) and chronic erythema nodosum. J Am Acad Dermatol. Mar 1990;22(3):477-83. [Medline].

  4. Fine RM, Meltzer HD. Chronic erythema nodosum. Arch Dermatol. Jul 1969;100(1):33-8. [Medline].

  5. Lee UH, Yang JH, Chun DK, Choi JC. Erythema nodosum migrans. J Eur Acad Dermatol Venereol. Jul 2005;19(4):519-20. [Medline].

  6. Requena L, Requena C. Erythema nodosum. Dermatol Online J. Jun 2002;8(1):4. [Medline]. [Full Text].

  7. Ross M, White GM, Barr RJ. Erythematous plaque on the leg. Vilanova's disease (subacute nodular migratory panniculitis). Arch Dermatol. Dec 1992;128(12):1644-5, 1647. [Medline].

  8. Perry HO, Winkelmann RK. Subacute nodular migratory panniculitis. Arch Dermatol. Feb 1964;89:170-9. [Medline].

  9. Schulz EJ, Whiting DA. Treatment of erythema nodosum and nodular vasculitis with potassium iodide. Br J Dermatol. Jan 1976;94(1):75-8. [Medline].

  10. Sterling JB, Heymann WR. Potassium iodide in dermatology: a 19th century drug for the 21st century-uses, pharmacology, adverse effects, and contraindications. J Am Acad Dermatol. Oct 2000;43(4):691-7. [Medline].

  11. Montgomery H, O'Leary P, Barker N. Nodular vascular diseases of the legs. JAMA. 1945;128:335-41.

  12. Niemi KM, Forstrom L, Hannuksela M, Mustakallio KK, Salo OP. Nodules on the legs. A clinical, histological and immunohistological study of 82 patients representing different types of nodular panniculitis. Acta Derm Venereol. 1977;57(2):145-54. [Medline].

[ CLOSE WINDOW ]

Further Reading

[ CLOSE WINDOW ]

Keywords

Vilanova disease, subacute nodular migratory panniculitis, chronic erythema nodosum, erythema nodosum migrans

[ CLOSE WINDOW ]

Contributor Information and Disclosures

Author

Sarah M Sawyer, MD, Staff Physician, Department of Dermatology, University of Alabama School of Medicine
Disclosure: Nothing to disclose.

Coauthor(s)

Daniel Davis, MD, Associate Professor, Departments of Dermatology, Otolaryngology, and Pathology, University of Arkansas for Medical Sciences
Disclosure: Nothing to disclose.

Vlada Groysman, MD, Staff Physician, Department of Dermatology, University of Alabama School of Medicine
Vlada Groysman, MD is a member of the following medical societies: American Academy of Dermatology, Medical Dermatology Society, and Women's Dermatologic Society
Disclosure: Nothing to disclose.

Medical Editor

Sungnack Lee, MD, Vice President of Medical Affairs, Professor, Department of Dermatology, Ajou University School of Medicine, Korea
Sungnack Lee, MD is a member of the following medical societies: American Dermatological Association
Disclosure: Nothing to disclose.

Pharmacy Editor

Richard P Vinson, MD, Assistant Clinical Professor, Department of Dermatology, Texas Tech University School of Medicine; Consulting Staff, Mountain View Dermatology, PA
Richard P Vinson, MD is a member of the following medical societies: American Academy of Dermatology, Association of Military Dermatologists, Texas Dermatological Society, and Texas Medical Association
Disclosure: Nothing to disclose.

Managing Editor

Christen M Mowad, MD, Associate Professor, Department of Dermatology, Geisinger Medical Center
Christen M Mowad, MD is a member of the following medical societies: Alpha Omega Alpha, American Academy of Dermatology, and Phi Beta Kappa
Disclosure: Nothing to disclose.

CME Editor

Catherine Quirk, MD, Clinical Assistant Professor, Department of Dermatology, Brown University
Catherine Quirk, MD is a member of the following medical societies: Alpha Omega Alpha and American Academy of Dermatology
Disclosure: Nothing to disclose.

Chief Editor

William D James, MD, Paul R Gross Professor of Dermatology, University of Pennsylvania School of Medicine; Vice-Chair, Program Director, Department of Dermatology, University of Pennsylvania Health System
William D James, MD is a member of the following medical societies: American Academy of Dermatology and Society for Investigative Dermatology
Disclosure: elsevier Royalty Other; american college of physicians Honoraria Other

 
 
HONcode

We subscribe to the
HONcode principles of the
Health On the Net Foundation

All material on this website is protected by copyright, Copyright© 1994- by Medscape.
This website also contains material copyrighted by 3rd parties.

DISCLAIMER: The content of this Website is not influenced by sponsors. The site is designed primarily for use by qualified physicians and other medical professionals. The information contained herein should NOT be used as a substitute for the advice of an appropriately qualified and licensed physician or other health care provider. The information provided here is for educational and informational purposes only. In no way should it be considered as offering medical advice. Please check with a physician if you suspect you are ill.