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Pathology

Authoring team

Erythema nodosum represents an inflammation of the septa in the subcutaneous adipose tissue (a septal paniculitis)

Evidence suggests that erythema nodosum develops as a type IV delayed hypersensitivity response to a number of antigens e.g. - streptococcal infection, tuberculosis, fungal infection, leprosy and some drugs.

The histopathology is distinctive:

  • early lesions show widening of the connective tissue between lobules and may be associated with haemorrhage
  • a characteristic finding of the disease is Actinic (Miescher's) radial granulomas – these are well demarcated, small, nodular collections of tiny histiocytes around a central stellate cleft
  • later there is an cellular infiltrate containing lymphocytes, histiocytes and multinucleate giant cells

Reference:

  1. Pérez-Garza DM, Chavez-Alvarez S, Ocampo-Candiani J, et al. Erythema nodosum: a practical approach and diagnostic algorithm. Am J Clin Dermatol. 2021 May;22(3):367-78.

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