(Erytheme indure des scrofuleux, Bazin)
Definition. – A rare, chronic, recurring, inflammatory disease of a scrofulous nature, characterized by circumscribed, purplish-red, nodular infiltrations involving the legs and disappearing by absorption or necrosis.
Symptoms. – The nodules occur successive crops and the whole condition may last for years but the appearance at any one time is that of single or multiple swellings, superficial or deep-seated in the skin, a quarter of an inch or more in width, but which often coalesce forming large areas of branny induration. The deep-seated nodules cause so little change in the color of the skin that they are often better felt than seen. The skin over the superficial lesions is at first bright red, later becoming livid; this same coloration may occur over the deeper indurations in their later stages. Slow resolution is the rule but sloughing and ulceration may ensue. Lesions are usually situated on the outer or posterior aspect of the leg below the knee and pain and tenderness are generally absent.
Etiology and Pathology. – This is a rare disease particularly among the well- to-do. It is usually found in females of from twelve to thirty years of age, whose occupations keep them standing for long periods at a time or whose circulation is weak. It is more common in the winter and has been noted in connection with other tubercular affections of the skin and general tuberculosis. The tubercular nature has been demonstrated although inoculation experiments have usually been negative and the bacillus has not been found in the lesions as yet. Nevertheless, the majority of investigators believe this condition to be a cutaneous manifestation of tuberculous infection.
Diagnosis. – The gummatous syphilid will be benefited by specific treatment. It shows a comparatively rapid course, is more sharply circumscribed, more painful and inflammatory and is rarely seen on both legs. Erythema nodosum is acute, does not ulcerate or form scars, has no associated tubercular features, is painful and tender and usually occurs on the tibial surfaces.
Prognosis and Treatment – Much may be accomplished if the patient’s cooperation can be obtained but the disease is persistent and obstinate. Physiological living is the aim as in all tubercular conditions. If not ulcerated, the legs should be firmly bandaged. If ulceration takes place, antiseptic dressings such as Lassar’s paste with the addition of 5 to 10 per cent. resorcin, or mercuric sulphid 1 per cent. in benzoated lard may be used, preceded by careful cleansing with hydrogen peroxid or hot boric acid solution. Rest in bed with elevation of the legs must be insisted upon when open sores are to be treated. See indications for Arsenicum iod., Aurum mur., Belladonna, Kali brom.