Erythema induratum Bazin

Last Updated: 2023-01-23

Author(s): Anzengruber F., Navarini A.

ICD11: EA5Y

Bazin 1861.

Bazin syndrome, Bazin`s disease, nodular tuberculid, nodular vasculitis, nodular vasculitis, nodular vasculitis, hypodermitis nodularis subacuta saltans (O'Leary), phlebitis nodularis, lipodermatosclerosis, vasculitis nodularis.

Hyperergic-allergic reaction of the small vessels.

  • Females > males
  • Preferring to younger age.
  • The occurrence is associated with increased sensitivity to cold (acrocyanosis, livedo reticularis) and pyknic constitution.

Tubercle bacilli are transported haematogenously to the acras, where a hyperergic-allergic reaction occurs. The reaction is assumed to be an Id reaction against the tuberculid. However, an association with tuberculosis cannot always be confirmed. In this case, the clinical finding is termed "nodular vasculitis“. „Erythema induratum Bazin“ is only used if an association with tuberculosis can be established.

  • Recurrent occurrence of dolent, erythematous-brownish, cutaneous and subcutaneous nodules and plaques. There may be central necrosis with melting.  Non-ulcerated nodules usually heal after 2-3 months, while ulcerated nodules often do not heal at all.

  • Clinical.
  • Tuberculin test.
  • Quantiferon test.
  • Dermatopathological findings.
  • Mycobacteria detection from biopsy.
  • To exclude systemic involvement:
  • Thoracic X-ray or CT- chest.
  • Sonography of abdomen and kidneys.
  • Collection of sputum in the morning (fasting for at least 4 hrs.) on 3 consecutive days.
  • Collection of urine in the morning (fasting for at least 4 hrs) on 3 consecutive days.
  • Bronchoalveolar lavage (BAL).

Extremities (US > OS), gluteal, upper arms and pectoral.

Growth atrophy, perivascular inflammation, fibrosis, granulomatous vasculitis and lobular panniculitis.

Years of chronic recurrence. Course with eventual, scarred healing.

  • Therapy regimen:
  • The initial phase should last for 8 weeks/2 months. During this time, the majority of the bacteria are killed. In the subsequent phase of therapy (lasting for months), attempts are made to eliminate the remaining bacteria. Antituberculous therapy should be continued for at least 2 months after the skin is free of symptoms.

 

  • Therapy should last individually between 12-24, but at least 6 months!

     

  • Induction phase (2 months):
  • Rifampicin p.o. 10 mg/kg bw/ d
  • Isoniazide p.o. 5 mg/kg bw. (with Vit B 6)
  • Pyrazinamide p.o. 35 mg/ bw/ d if necessary combination with allopurinol!
  • Ethambutol p.o. 15 mg/kg bw/ d
  • A clear improvement can be seen in the vast majority of cases after 1 ½ months.

 

  • Consolidation phase:
  • Induction phase (2 months):
  • Rifampicin p.o. 10 mg/kg bw/ d
  • Isoniazide p.o. 5 mg/kg bw. (with Vit B 6)
  • Ethambutol p.o. 15 mg/kg bw/d (can also be omitted if isoniazid resistance has been ruled out)
  • HIV patients: therapy must be given for 7 months. Ethambutol should be replaced by streptomycin p.o. 15-20 mg/kg bw/d (from 60 years max 750 mg) in case of additional therapy with NNRTI.

  1. Segura S, Pujol RM, Trindade F , Requena L. Vasculitis in erythema induratum of Bazin: A histopathologic study of 101 biopsy specimens from 86 patients. Journal of the American Academy of Dermatology 2008;59:839-51.
  2. Kim GW, Park HJ, Kim HS, Chin HW, Kim SH, Ko HC et al. Simultaneous occurrence of papulonecrotic tuberculid and erythema induratum in a patient with pulmonary tuberculosis. Pediatr Dermatol 2013;30:256-9.
  3. Park YM, Hong JK, Cho SH , Cho BK. Concomitant lichen scrofulosorum and erythema induratum. Journal of the American Academy of Dermatology 1998;38:841-3.