ERYTHEMA NODOSUM

 Basic information

description

Erythema nodosum is an inflammatory disorder of the skin and the tissue under the skin. It is not contagious. It usually affects the skin of the legs, especially areas over the large bone (shin bone) in the lower leg. It can affect all ages, but is more likely to occur in females (ages 20 to 45).

FREQUENT SIGNS & SYMPTOMS

• A flu-like infection may precede the skin symptoms by 1 to 2 weeks. There may be a period of feeling generally unwell and fever. Joint aches may occur, especially of the knee.
• Red lumps (also called lesions or nodules) appear on the shins or about the knees or ankles. They vary in size from a cherry to a grapefruit. There may be 2 to 50 or more.
• The lumps are raised slightly above the skin. They are hot and painful. The color is bright red to start, then purple, and then fades to a bruise-like color.
• Other, smaller, red lumps may appear on the outer arms, face, and neck.
• Lumps continue to appear for about 10 days or more.
• Conjunctivitis (eye inflammation) may occur.

causes

It appears to be a hypersensitivity reaction to different causes (e.g., infection, use of certain drugs, or other factors). Often, no cause is found.

risk increases with

• Drugs, such as birth-control pills (especially those high in estrogen), sulfonamides, iodides, and bromides.
• A preceding infection, including Streptococcus (most common), coccidioidomycosis, histoplasmosis, sarcoidosis, blastomycosis, tuberculosis, and Yersinia infections.
• Autoimmune disease.
• Chronic bowel inflammation.
• Cancer.
• Pregnancy.

PREVENTIVE MEASURES

Remove or treat the cause if it can be identified.

expected outcomes

Lumps diminish in size and tenderness and heal in about 3 to 6 weeks. Complete healing may take several months. It does not leave scars. In some cases, joint aches may continue for months to years.

possible complications

• None expected from erythema nodosum.
• Less than 20% of cases recur.
• Other complications can arise depending on the underlying cause.

 diagnosis & treatment

general measures

• Your health care provider will do an exam of the affected skin. Medical tests are not needed to diagnose erythema nodosum, but they may be done to diagnose an underlying disorder.
• Erythema nodosum often heals on its own. Symptoms may be treated with drug therapy. Treatment may be provided for an underlying disorder. If a drug is the cause of the disorder, it will normally be discontinued.
• For self-care
  • Elevate the legs whenever possible.
  • Use elastic wrap or support stockings.
  • Soak the affected areas in water. Warm-water soaks are usually more soothing for pain or inflammation. Cool-water soaks feel better for itching.

medications

• For minor discomfort, use nonprescription drugs such as aspirin (not for children) or other nonsteroidal anti-inflammatory drugs.
• Potassium iodide may be prescribed.
• Corticosteroids may be prescribed in very severe cases.
• Topical drugs for the skin usually do not help.

activity

Rest in bed as much as possible with the legs elevated. This may help prevent new lumps from developing. When symptoms improve, resume normal activity.

diet

No special diet.

 notify our office if

• You or a family member has symptoms of erythema nodosum.
• Any new symptoms arise that you think may be due either to the disorder or the drugs prescribed.

Special Notes: