Erythema induratum A18.4

Bazin, 1861

Rare, chronic, gynecotropic, mostly symmetrical, "infectious allergic" lobular panniculitis combined with vasculitis of the small vessels of the fat lobules. The dorsal parts of the lower leg are mainly affected, which has been interpreted as a hyperergic reaction to Mycobacterium tuberculosis (see tuberculosis below).

Increased incidence in Japan and China (35%-40% of cutaneous tuberculosis)

A necrotizing vasculitis of medium vessels is discussed as a hyperergic (Id reaction) against Mycobacterium tuberculosis (= tuberculoid); also in atypical mycobacterioses.

If an association with tuberculosis can be considered certain (detection of mycobacterial DNA from biopsy material; therapeutic success with tuberculostatics!), the diagnosis "Erythema induratum Bazin" can be made for historical reasons. If this causal relationship is missing, many authors prefer the neutral clinical diagnosis of nodular vasculitis or nodular vasculitis.

Other infectious and non-infectious triggers are discussed:

• constitutional type (acrocyanosis, livedo reticularis, lipedema)
• Chronic exposure to cold
• Crohn's disease (K50.9) (Misago N et al. 2012)
• streptococci
• Hepatitis C
• HIV

Predominantly young women

Inflammatory, in interval phases only moderately painful, in recurrent phases clearly painful, red to brown-red, firm, cutaneous or subcutaneous nodules and plaques. Size: 2.5 cm, rarely up to 10 cm. Frequently, but not always, occurring with mostly deep, central necrotic melting and subsequent roundish, poorly healing ulceration. Extremely chronic or chronically recurrent course over several years possible. Healing leaving brownish pigmented, sunken scars.

Frequent accompanying symptoms: acrocyanosis, livedo reticularis, erythrocyanosis crurum puellarum, perniosis follicularis.

For further information see below. Nodular vasculitis

1. Bazin PAE (1861) Leçons théoriques et cliniques sur la scrofule, considérée en ellemême et dans ses rapports avec la syphilis, la dartre et l'arthritis. Adrien Delahaye (París), 2nd edition, pp. 145, 501
2. Bilan P et al. (2015) Cutaneous tuberculosis and erythema induratum: A retrospective study of 13 cases in France. Ann Dermatol Venereol 142: 237-244
3. Braun-Falco O et al. (1995) On the tuberculid concept from today's perspective. Dermatologist 46: 383-387
4. Chang MW (1999) Erythema induratum of Bazin in an infant. Pediatrics 103: 498-499
5. Campbell SM et al. (2013) Erythema Induratum Caused by Mycobacterium chelonei in an Immunocompetent Patient. J Clin Aesthet Dermatol 6:38-40
6. Degitz K (1993) Successful treatment of erythema induratum of bazin following rapid detection of mycobacterial DNA by polymerase chain reaction. Arch Dermatol 129: 1619-1620
7. Fischer C et al. (2011) Successful treatment of nodular vasculitis with adalimumab (Humira®). Abstract CD 46th DDG Conference: P16/15
8. Gramminger C et al (2025) Recognizing cutaneous tuberculosis. J Dtsch Dermatol Ges 23:793-802.
9. Heinemann C (2000) Erythema induratum of Bazin and Poncet's disease -- successful treatment with antitubercular drugs. J Eur Acad Dermatol Venereol 17: 334-336
10. Jacinto SS (2003) Erythema induratum of bazin: role of polymerase chain reaction in diagnosis. Int J Dermatol 42: 380-381
11. Marker M et al (2004) Erythema induratum bazin nodular vasculitis. JDDG 3: 206-213
12. Misago N et al. (2012) Erythema induratum (nodular vasculitis) associated with Crohn's disease: a rare type of metastatic Crohn's disease. Am J Dermatopathol 34:325-329.
13. Müller CSL et al. (2016) Diagnostics and histologic features of cutaneous vasculitis/vasculopathies. Act Dermatol 42: 286-301
14. Ratzinger G et al. (2015) The vasculitis wheel-an algorithmic approach to cutaneous vasculitides. JDDG 1092-1118
15. Sharma S et al. (2015) Clinicopathologic Spectrum of Cutaneous Tuberculosis: A Retrospective Analysis of 165 Indians. Am J Dermatopathol 37: 444-450
16. Teramura K et al (2014) Disseminated erythema induratum of Bazin. Eur J Dermatol 24:697-698