Erythema Nodosum

Alternative Names

Erythema nodosum

What is Erythema Nodosum

Erythema nodosum is a type of skin inflammation that is located in a certain portion of the fat beneath the skin’s surface. Erythema nodosum characterized by lumps or nodules beneath the skin that are about an inch across and are firm, red, and warm to the touch. The tender lumps, or nodules, of erythema nodosum range in size from 1 to 5 centimeters. The nodular swelling is caused by a special pattern of inflammation in the fatty layer of skin.

It can be self-limited and resolve on its own in 3 to 6 weeks. Upon resolution, it may leave only a temporary bruised appearance or leave a chronic indentation in the skin where the fatty layer has been injured.

Signs and symptoms

Erythema nodosum is most common on the shins, but it may also occur on other areas of the body such as buttocks, calves, ankles, thighs, and arms.

The damages begin as flat, firm, hot, red, painful lumps approximately an inch across. Within a few days they may become purplish and then over several weeks fade to a brownish, flat patch.

Other symptoms may include the followings:

• Fever
• General ill feeling (malaise)
• Joint aches
• Skin redness, inflammation, or irritation
• Swelling of the leg or other affected area
• The red and inflamed skin symptoms may regress to a bruise-like appearance.

Possible complications

Complications from erythema nodosum are unusual, and constant scarring will hardly occur.

What causes

Most often, the exact cause of erythema nodosum is not known, but it has been linked to a variety of other infections, most commonly strep throat. Less often, it can be the first sign of a systemic disease, such as tuberculosis, inflammatory bowel disease, bacterial or deep fungal infection, sarcoidosis (inflammatory disease most commonly affecting the lungs, skin and eyes), or, rarely, cancer. It can also be a reaction to medications, such as antibiotics or oral contraceptives.

Prevention

The exact ways of prevention are not known. However it is recommended:

• Bed rest is advised for severe EN.
• Firm supportive bandages or stockings should be worn.
• Topical therapy is not generally needed, although hot or cold compresses may reduce discomfort.

Treatment

If you have an erythema nodosum, your doctor will attempt to identify the probable cause, such as infection, medical condition, or medication. Your doctor can order diagnostic test such as blood work, throat culture or chest x-ray. If there is an underlying cause identified, then the physician will treat it appropriately – for example, discontinuing a medication, treating a health problems or prescribing antibiotics for an infection.

Once those treatment and investigations are under way, your doctor can try the following to make you comfortable:

• Restriction of any physical activity or bed rest – especially during acute pain
• Anti-inflammatory medications such as aspirin or ibuprofen
• Potassium iodide – to heal nodules
• Steroids – either oral form or injected directly into the lesions
• Colchicine – reduces inflammation

Gentle heat like a soapy warm wash cloth held on the region for thirty minutes 3 to 4 times each day can help speed up the process of healing

Erythema nodosum treatment is aimed to relieve any pain and discomfort of the skin nodules until they resolve, normally within a couple of weeks. Treatment must be customized for the particular patients and conditions present.

It is very important to note that erythema nodosum, while painful and very annoying, does not threaten internal organs and the long-term outlook is generally very good.