Shin Lesions

Question 1

What is erythema nodosum?

Answer 1

Panniculitis caused by inflammation of SC fat

Leads to painful., tender, erythematous nodular lesions on the shin
Normally heals without scarring

Question 2

What are causes of erythema nodosum?

Answer 2

Infection- TB/strep
IBD
Sarcoidosis
Pregnancy
Behcets
Drugs- COCP, penicillins, sulphonamides

Question 3

What is Pyoderma Gangrenosum?

Answer 3

Non infectious inflammatory disorder
Can affect any part of the skin but normally on lower limb

Starts quite suddenly as small pustule/red bump/blister
Skin then breaks down into deep expanding ulcer which can be necrotic
Ulcer is painful and have a violaceous border

Question 4

What are causes of Pyoderma Gangrenosum?

Answer 4

Idiopathic= majority
AI disease e.g. IBD/RA/SLE
Haematological malignancy- leukaemia/lymphoma

Question 5

What is the diagnosis and management of Pyoderma Grangrenosum?

Answer 5

Often clinical diagnosis

Can treat with high dose oral steroids/immunosuppressive therapy in difficult cases

Question 6

What is Necrobiosis Lipodica Diabeticorum?

Answer 6

A granulomatous skin disorder which occurs due to diabetes

NLD starts as small red papules on shins, usually bilaterally
May have telangiectasia
Normally painless but can be tender

Question 7

What is Pretibial Myxoedema?

Answer 7

Feature of Graves disease
Symmetrical erythema of the shins with swelling and shiny skin
May have other features of Graves