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 Examination

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 in most cases, but reports document streptococcal infection, viral infection, and medications as causes in some patients.^{[12, 13, 14]}

Differential Diagnoses

Bafverstedt B. Not Available. Acta Derm Venereol. 1954. 34(3):181-93. [QxMD MEDLINE Link].
Vilanova X, Pinol Aguade J. Subacute Nodular Migratory Panniculitis. Br J Dermatol. 1959 Feb. 71(2):45-50. [QxMD MEDLINE Link].
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. 1990 Mar. 22(3):477-83. [QxMD MEDLINE Link].
Fine RM, Meltzer HD. Chronic erythema nodosum. Arch Dermatol. 1969 Jul. 100(1):33-8. [QxMD MEDLINE Link].
Vanegas ES, Cendejas RF, Mondragón A. A 41-year-old woman with migratory panniculitis. Am J Trop Med Hyg. 2014 May. 90(5):786-7. [QxMD MEDLINE Link]. [Full Text].
Chowaniec M, Starba A, Wiland P. Erythema nodosum - review of the literature. Reumatologia. 2016. 54 (2):79-82. [QxMD MEDLINE Link].
Sehrawat M, Dixit N, Sardana K, Malhotra P. Exploring the combination of SSKI and topical heparin in a case of erythema nodosum migrans. Dermatol Ther. 2018 Jul. 31 (4):e12610. [QxMD MEDLINE Link].
Smith MP, Ly K, Thibodeaux Q, Bhutani T. Chronic erythema nodosum with koebnerization to plaque psoriasis. Int J Womens Dermatol. 2019 Dec. 5 (5):387-388. [QxMD MEDLINE Link]. [Full Text].
Ross M, White GM, Barr RJ. Erythematous plaque on the leg. Vilanova's disease (subacute nodular migratory panniculitis). Arch Dermatol. 1992 Dec. 128(12):1644-5, 1647. [QxMD MEDLINE Link].
Sandoval M, Giesen L, Cataldo K, González S. Postirradiation Pseudosclerodermatous Panniculitis of the Leg: Report of a Case and Review of the Literature. Am J Dermatopathol. 2014 Jun 17. [QxMD MEDLINE Link].
Lee UH, Yang JH, Chun DK, Choi JC. Erythema nodosum migrans. J Eur Acad Dermatol Venereol. 2005 Jul. 19(4):519-20. [QxMD MEDLINE Link].
Requena L, Requena C. Erythema nodosum. Dermatol Online J. 2002 Jun. 8(1):4. [QxMD MEDLINE Link]. [Full Text].
Liu Y, Guan Y, Liu H, Bian Q. Highly suspected valsartan-induced chronic erythema nodosum migrans in a patient with hypertension: a case report. J Int Med Res. 2022 Feb. 50 (2):3000605221079553. [QxMD MEDLINE Link]. [Full Text].
Shibata A, Ishiguro Y, Makita S, et al. A systemic form chronic active Epstein-Barr virus infection diagnosed from erythema nodosum-like skin lesions. Eur J Dermatol. 2020 Jun 1. 30 (3):314-316. [QxMD MEDLINE Link].
Mufti A, Al-Mohammedi F, Alavi A. An unusual presentation of Vilanova disease (erythema nodosum migrans) with superficial histologic changes. JAAD Case Rep. 2016 Jan. 2 (1):41-3. [QxMD MEDLINE Link].
Rose C, Leverkus M, Fleischer M, Shimanovich I. Histopathology of panniculitis - aspects of biopsy techniques and difficulties in diagnosis. J Dtsch Dermatol Ges. 2011 Nov 16. [QxMD MEDLINE Link].
Perry HO, Winkelmann RK. Subacute nodular migratory panniculitis. Arch Dermatol. 1964 Feb. 89:170-9. [QxMD MEDLINE Link].
Schulz EJ, Whiting DA. Treatment of erythema nodosum and nodular vasculitis with potassium iodide. Br J Dermatol. 1976 Jan. 94(1):75-8. [QxMD MEDLINE Link].
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. 2000 Oct. 43(4):691-7. [QxMD MEDLINE Link].
Mokhtari F, Abtahi-Naeini B, Pourazizi M. Erythema nodosum migrans successfully treated with indomethacin: A rare entity. Adv Biomed Res. 2014. 3:264. [QxMD MEDLINE Link].

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Author

Dirk M Elston, MD Professor and Chairman, Department of Dermatology and Dermatologic Surgery, Medical University of South Carolina College of Medicine

Dirk M Elston, MD is a member of the following medical societies: American Academy of Dermatology

Disclosure: Nothing to disclose.

Specialty Editor Board

Richard P Vinson, MD Assistant Clinical Professor, Department of Dermatology, Texas Tech University Health Sciences Center, Paul L Foster 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, Texas Medical Association, Association of Military Dermatologists, Texas Dermatological Society

Disclosure: Nothing to disclose.

Christen M Mowad, MD Professor, Department of Dermatology, Geisinger Medical Center

Christen M Mowad, MD is a member of the following medical societies: Alpha Omega Alpha, Noah Worcester Dermatological Society, Pennsylvania Academy of Dermatology, American Academy of Dermatology, Phi Beta Kappa

Disclosure: Nothing to disclose.

Chief Editor

William D James, MD Paul R Gross Professor of Dermatology, Vice-Chairman, Residency Program Director, Department of Dermatology, University of Pennsylvania School of Medicine

William D James, MD is a member of the following medical societies: American Academy of Dermatology, Society for Investigative Dermatology

Disclosure: Received income in an amount equal to or greater than $250 from: Elsevier; WebMD<br/>Served as a speaker for various universities, dermatology societies, and dermatology departments.

Additional Contributors

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 Academy of Dermatology

Disclosure: Nothing to disclose.

Vlada Groysman, MD Medical Director, Cahaba Dermatology and Skin Health Center; Clinical Assistant Professor of Dermatology, University of Alabama at Birmingham School of Medicine

Vlada Groysman, MD is a member of the following medical societies: American Academy of Dermatology, Women's Dermatologic Society, Medical Dermatology Society

Disclosure: Nothing to disclose.

Acknowledgements

Daniel Davis, MD Associate Professor, Departments of Dermatology, Otolaryngology, and Pathology, University of Arkansas for Medical Sciences

Disclosure: Nothing to disclose.

Sarah B Sawyer, MD Dermatology and Laser of Alabama

Sarah B Sawyer, MD is a member of the following medical societies: American Academy of Cosmetic Surgery, American Academy of Dermatology, American Society for Dermatologic Surgery, and American Society for Laser Medicine and Surgery

Disclosure: Nothing to disclose.