Erythema Induratum of Bazin

ERYTHEMA INDURATUM OF BAZIN (erythema induratum Bazin), a chronic inflammatory disease of the skin, first described by Bazin in 1861. It occurs (most often in young women) in the form of infiltrates of a uniform purplish-pink color, usually deep, dense, plaque-like, painless to the touch, and with indistinct, irregular borders. Typical localization: the lower lateral sides of the shins, less often the thighs, and the upper extremities (sometimes the forehead). The course of the disease is chronic with exacerbations; after healing, recurrences are possible. In rare cases (the English type of Hutchinson), torpid ulcers develop that are little inclined to heal (ecthyma scrofulosorum). These ulcers can reach significant size and depth, usually have irregular outlines and an uneven, grayish-red, depressed, and dense base. Their edges present the purplish coloration and significant density typical for erythema induratum of Bazin. Histologically, in erythema induratum of Bazin, a tuberculoid structure is quite often (but not necessarily) observed, sometimes with foci of necrosis. Changes in the vessels, especially venous ones, are characteristic (endophlebitis—Thibierge and Ravaut, Leredde, and others). In diagnosis, it is sometimes difficult to distinguish erythema induratum of Bazin from sarcoids, which generally present as smaller and more limited nodular formations without ulcerations. Histologically, a tuberculoid structure is more consistently found in sarcoids. The differential diagnosis of erythema induratum of Bazin from oleogranulomas (vaselinomas, eleidomas, etc.) is also difficult. The formation of these tumors at injection sites, acute development with pain, sharp tenderness, and a peculiar copper-red color are characteristic signs of oleogranulomas. These also include the so-called spontaneous oleogranulomas, studied primarily by Russian researchers (Abrikosov, Vail, and others). They develop in connection with necrotic changes in adipose tissue of various origins, often arising after severe infections (typhus). Clinically, the formation of infiltrates of a chronic inflammatory nature is also observed here, usually of a more nodular appearance, and therefore more often resembling sarcoids. In doubtful cases, histological examination is necessary. Erythema induratum of Bazin is often accompanied by tuberculosis of internal organs, bones, glands, skin, or various types of tuberculids. Successful experiments of inoculating tuberculosis into guinea pigs with tissue from erythema induratum of Bazin have been described (Thibierge and Ravaut, C. Fox, and others), and cases of finding tubercle bacilli in the tissue of erythema induratum of Bazin have even been observed (Philippson, Jadassohn). Upon injection of tuberculin, a focal reaction is obtained. All this inclines the majority of dermatologists to recognize an etiological connection between erythema induratum of Bazin and tuberculosis. In some cases, the clinical picture of erythema induratum of Bazin is observed even without a connection to tuberculosis (Jadassohn). The study of oleogranulomas opens new possibilities for understanding the pathogenesis of erythema induratum of Bazin. Treatment. In addition to general strengthening measures (warm climate, sun, rest, and a fattening diet), good results are given by arsenic (or arsenobenzene preparations) or tuberculin injections (minimal doses and preferably intradermally). Darier recommends a combination of intravenous infusions of 914 and intradermal injections of tuberculin (0.01–0.03). Cautious treatment with iodine is recommended. Massage and intensive heat treatment are contraindicated for this disease.