Clinical and Histopathological Study of Erythema Nodosum-Like Lesions in Patients with Behcet's Disease

Jang, Eun Joo; Lee, Ji Yeoun; Kim, Mi Kyeong; Yoon, Tae Young

Abstract

BACKGROUND
The clinical and histopathological aspects of erythema nodosum-like lesions (ELLs) in patients with Behcet's disease (BD) may resemble those of classic erythema nodosum (EN). Although a few articles that compared ELL and EN in Korean patients have been published in the English literature, there is no comparative study between ELL and EN in the Korean dermatologic literature.
OBJECTIVE
The purpose of this study was to evaluate the clinical and histopathological differences between ELL and EN.
METHODS
We reviewed all the medical records, photographs and histopathological slides of 33 patients with ELL and 47 patients with EN at our clinic between 2000 and 2009. For all the patients, their diagnosis was confirmed based upon the clinicopathologic correlation and long term follow-up of at least more than 1 year.
RESULTS
Compared with EN, ELLs were associated with the following characteristics: a past history of inflammatory plaques and nodules (p=0.037), a relapsing course (p<0.001), dermal infiltration of neutrophils (p=0.001), mixed panniculitis (p<0.001) and subcutaneous vasculitis (p<0.001). In 6 patients (18.2%) the ELLs were the initial major symptom of BD and they didn't have other main symptoms of BD. Compared with the patients with EN, all these patients had inflammatory plaques or nodules on other areas as well as on the lower extremities (p=0.006) and they had a relapsing course (p<0.001). In this group the mean duration of an initial major symptom to the diagnosis of BD was 16.7 months.
CONCLUSION
Our results show that ELLs in BD can be distinguished from EN by some clinical and histopathological differences. Especially, in the patient with ELLs without other main symptoms of BD, the occurrence of lesions above the lower extremities and the relapsing course may be important clues to suspect a diagnosis of BD and to exclude a diagnosis of EN.