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October 1993

Multiple Tender, Erythematous Subcutaneous Nodules on the Lower Extremities

Author Affiliations

Baylor College of Medicine, Houston, Tex, and Loma Linda (Calif) University

Arch Dermatol. 1993;129(10):1331-1332. doi:10.1001/archderm.1993.01680310101019

REPORT OF A CASE  A 42-year-old white woman underwent bilateral leg sclerotherapy with hypertonic saline in May 1988. Subsequent to this, multiple 1- to 2-cm, tender, erythematous, firm subcutaneous nodules developed on both legs. A punch biopsy specimen was interpreted as erythema nodosum. An extensive workup for collagen vascular and infectious diseases was negative. She received trials of tetracycline, prednisone, and potassium iodide, with a limited response to prednisone only.In February 1989, dermatitis herpetiformis developed. This diagnosis was confirmed by skin biopsy and direct immunofluorescence. This problem remains under control with dapsone (150 mg/d orally).Physical examination revealed multiple 1to 2-cm erythematous tender nodules on both legs (Figure 1). The nodules were more prevalent on the anterior aspect of the legs with some on the posterior aspect of the legs and thighs. No regional adenopathy was present, and the remainder of the physical examination showed normal findings except

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