Erythema Induratum (Nodular Vasculitis) Differential Diagnoses

Updated: Nov 20, 2020
  • Author: Esther A Balogh, MD; Chief Editor: William D James, MD  more...
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Diagnostic Considerations

Erythema induratum (nodular vasculitis) must be distinguished from the following:

  • Erythema nodosum (EN) [2] : EN has a relatively short duration, develops rapidly, and mainly affects the anterior rather than posterior lower limb. EN lesions consist of tender, painful, scarlet or contusiform nodules that appear spontaneously and do not ulcerate. Histologically, septal panniculitis is seen. EN is generally more painful than erythema induratum.
  • Cutaneous polyarteritis nodosa (PAN): Cutaneous PAN presents as tender, erythematous, purpuric macules, papules, and nodules, often occurring in a livedoid pattern on the lower extremity. Histologically, cutaneous PAN is centered around small subcutaneous arteries rather than broader subcutaneous inflammation on many vessel types as in erythema induratum.
  • Tertiary syphilis: Gummas are usually unilateral and single or may appear as a small, distinct group of lesions.
  • Other infectious panniculitides (panniculitis caused by Mycobacterium massiliense [40] )
  • Inflammatory panniculitides (eg, pancreatic panniculitis, lupus panniculitis, alpha-1 antitrypsin deficiency panniculitis, subcutaneous panniculitic T-cell lymphoma) [2]
  • Traumatic panniculitis (TP): TP occurs as one or a few tender or asymptomatic nodules. TP can occur at any site, the anterior leg (shin) being the most common location. Factitial panniculitis is a subtype of TP. Histologically, there is prominent fat necrosis but no vasculitis.

Differential Diagnoses

  • Cutaneous polyarteritis nodosa (PAN)

  • Erythema Nodosum

  • Inflammatory panniculitis

  • Other infectious panniculitis (eg, M massiliense)

  • Tertiary syphilis

  • Traumatic panniculitis