Erythema Induratum of Bazin
Section snippets
The concept of tuberculids
The concept of tuberculids was introduced by Jean Darier2 in 1896 to designate a group of dermatoses in individuals with a previous history of active TB who had a tuberculoid histopathology and presented with an intense reaction to tuberculin. All the bacteriologic methods that were available at that time for demonstrating a tuberculous origin (ie, cultures from cutaneous lesions demonstrating MTB) were negative. The tuberculids included initially lichen scrofulosum, papulonecrotic tuberculids,
Clinical features of erythema induratum of Bazin
Typical patients who present with EIB are usually young to middle-aged women. They present with recurrent flares of violaceous nodules or deep-seated plaques on the legs (Fig. 1).1, 6, 7, 8 The lesions are cold, are surprisingly not painful, and have a tendency to central ulceration. The superficial skin tends to show desquamation that forms a scaly collarette around the lesions or crusts overlying the ulcers. Most lesions resolve spontaneously within a few months, leaving postinflammatory
Pathology of erythema induratum of Bazin
EIB is a lobular panniculitis that shows a granulomatous inflammation with focal necrosis, vasculitis, and septal fibrosis in varying combinations.1, 6, 7, 8, 10 The histologic pattern greatly depends on the time that the biopsy was conducted during the disease evolution. The primary finding is a lobular panniculitis, sometimes showing a mixed pattern with septal and lobular inflammation (Fig. 2). The lobular inflammatory pattern can be initially focal, limited to the areas around a vessel, or
Historic evolution of the concept of erythema induratum of Bazin and its relationship with nodular vasculitis
Bazin11 first described EIB in 1855, a time when the tubercle bacillus had not yet been identified, as a condition occurring more frequently “on the legs of female laundresses and in young and plump, well-nourished women with the typical phenotype of those with scrofula.” Bazin11 classified EIB in the group of benign erythematous scrofulids, in which he included cuperosis, perniosis, and EIB. When MTB was discovered in 1882 and mycobacteria were found within cervical lymph nodes, the term
The relation of erythema induratum of Bazin with Mycobacterium tuberculosis infection
The causal relationship between EIB and TB has been based on a few circumstantial pieces of evidence in some patients, such as (1) a high degree of hypersensitivity to tuberculin skin testing in most patients,24, 25 (2) a frequent personal or family history of TB (the percentage of EIB patients with chest radiographic findings that suggest TB varies from 2% to 65%)24, 25, (3) presence of an active TB foci, (4) occasional coexistence with other tuberculids, such as papulonecrotic tuberculids or
Differential diagnosis
EIB can be easily mistaken for any of the diseases that produce chronic, nodular eruptions on the legs, including—but not limited to—erythema nodosum, cutaneous polyarteritis nodosa, sclerosing panniculitis, perniosis (chilblains), pancreatic paniculitis, lupus erythematosus profundus, and subcutaneous panniculitis-like T-cell lymphoma. A complete clinical history and physical examination are necessary in all cases. In many patients, performing an incisional biopsy with an adequate amount of
Diagnosis
The diagnosis of EIB is usually made on the basis of the characteristic clinical morphology, a positive tuberculin test, and circumstantial evidence of TB elsewhere in the body, supplemented by histopathologic findings. Detection of MTB DNA by PCR on the biopsy specimen further supports the diagnosis; however, failure to detect MTB by PCR does not exclude the diagnosis of EIB. For many dermatologists, the diagnosis can be confirmed by a good response to antituberculous treatment. In cases with
Treatment
In most patients who have EIB or NV, simple measures such as resting, using nonsteroidal anti-inflammatory drugs, and using compression stockings or supportive bandages can lead to complete remission of the lesions. In more severe cases, use of potassium iodide,40, 41 dapsone,22 colchicine,42 antimalarials, tetracyclines, gold salts,43 and prednisone can be successful in alleviating symptoms and inducing lesion remission, although they do not avoid late recurrences.
Many authors also favor
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