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Erythema nodosum is the most common and best individualized of the acute panniculitis. Diagnosis is usually made on clinical basis. Erythema nodosum is a septal panniculitis involving the septa between fat lobules, with an absence of vasculitis. The etiological investigation should be adapted to the country and, considering the frequency of idiopathic forms, the workup should be oriented to the particular case.
The pathophysiology of erythema nodosum remains poorly elucidated. The absence of vasculitis or thrombotic vasculopathy argues against a true immune complex disease, despite the presence in early stages of immunoglobulin and complement deposits in the blood vessels of the hypodermis.
IL-2 and interferon γ levels are significantly increased in blood and target tissues, reflecting a polarization of the immune response towards a “Th1 immune response” observed in cell-mediated hypersensitivity reactions. A better understanding of the etiopathogenic phenomena underlying this inflammatory reaction of the subcutaneous fat is an essential step for better management of the disease.
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