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Erythema nodosum

 

Erythema nodosum is an inflammatory disorder. It involves tender, red bumps ( nodules ) under the skin.

Causes

In about half of cases, the exact cause of erythema nodosum is unknown.

Some cases may occur with infections. Some of the more common infections are:

  • Streptococcus (most common)
  • Cat scratch disease
  • Chlamydia
  • Coccidioidomycosis
  • Hepatitis B
  • Histoplasmosis
  • Leptospirosis
  • Mononucleosis (EBV)
  • Mycobacteria
  • Mycoplasma
  • Psittacosis
  • Syphilis
  • Tuberculosis
  • Tularemia
  • Yersinia

Erythema nodosum may occur with sensitivity to certain medicines, including:

  • Antibiotics, including amoxicillin and other penicillins
  • Sulfonamides
  • Sulfones
  • Birth control pills
  • Progestin

Sometimes, erythema nodosum may occur during pregnancy.

Other disorders linked to this condition include leukemia, lymphoma, sarcoidosis, rheumatic fever , Bechet disease, and ulcerative colitis .

The condition is more common in women than it is in men.

Symptoms

 

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

The lesions begin as flat, firm, hot, red, painful lumps that are about 1 inch (2.5 centimeters) across. Within a few days, they may become purplish in color. Over several weeks, the lumps fade to a brownish, flat patch.

Other symptoms may include:

  • Fever
  • General ill feeling (malaise)
  • Joint aches
  • Skin redness, inflammation, or irritation
  • Swelling of the leg or other affected area

 

Exams and Tests

 

Your doctor can diagnose this condition by looking at your skin. Tests that may be done include:

  • Punch biopsy of a nodule
  • Throat culture to rule out a strep infection
  • Chest x-ray to rule out sarcoidosis or tuberculosis

 

Treatment

 

The underlying infection, drug, or disease should be identified and treated.

Treatment may include:

  • Nonsteroidal anti-inflammatory drugs (NSAIDs) to reduce pain and swelling.
  • Stronger anti-inflammatory medicines called steroids, taken by mouth or given as a shot.
  • Potassium iodide (SSKI) solution to clear up the nodules.
  • Salicylate medicines to reduce acute inflammation.
  • Pain medicines (analgesics).
  • Rest.
  • Raising the sore area (elevation).
  • Hot or cold compresses to help reduce discomfort.

 

Outlook (Prognosis)

 

Erythema nodosum is uncomfortable, but not dangerous in most cases.

Symptoms most often go away within about 6 weeks, but may return.

 

When to Contact a Medical Professional

 

Call your health care provider if you develop symptoms of erythema nodosum.

 

 

Open References

References

Ferri FF. Erythema nodosum. In: Ferri FF, ed. Ferri's Clinical Advisor 2016 . Philadelphia, PA: Elsevier; 2016:486-486.

Schwartz RA, Nervi SJ. Erythema nodosum: a sign of systemic disease. Am Fam Physician . 2007;75(5):695-700. PMID: 17375516 www.ncbi.nlm.nih.gov/pubmed/17375516 . 

 
  • Erythema nodosum associated with sarcoidosis

    Erythema nodosum associated with sarcoidosis - illustration

    This picture shows reddish-purple, hard (indurated), painful nodules (Erythema nodosum) that occur most commonly on the shins. These lesions may be anywhere on the body and may be associated with tuberculosis (TB), sarcoidosis, coccidioidomycosis, systemic lupus erythematosis (SLE), fungal infections, or in response to medications.

    Erythema nodosum associated with sarcoidosis

    illustration

  • Erythema nodosum on the foot

    Erythema nodosum on the foot - illustration

    This person has erythema nodosum nodules on the feet. The feet are red and painful. This disorder is associated with drugs or infections.

    Erythema nodosum on the foot

    illustration

    • Erythema nodosum associated with sarcoidosis

      Erythema nodosum associated with sarcoidosis - illustration

      This picture shows reddish-purple, hard (indurated), painful nodules (Erythema nodosum) that occur most commonly on the shins. These lesions may be anywhere on the body and may be associated with tuberculosis (TB), sarcoidosis, coccidioidomycosis, systemic lupus erythematosis (SLE), fungal infections, or in response to medications.

      Erythema nodosum associated with sarcoidosis

      illustration

    • Erythema nodosum on the foot

      Erythema nodosum on the foot - illustration

      This person has erythema nodosum nodules on the feet. The feet are red and painful. This disorder is associated with drugs or infections.

      Erythema nodosum on the foot

      illustration

    A Closer Look

     
     

    Review Date: 7/23/2015

    Reviewed By: Kevin Berman, MD, PhD, Atlanta Center for Dermatologic Disease, Atlanta, GA. Review provided by VeriMed Healthcare Network. Also reviewed by David Zieve, MD, MHA, Isla Ogilvie, PhD, and the A.D.A.M.

    The information provided herein should not be used during any medical emergency or for the diagnosis or treatment of any medical condition. A licensed medical professional should be consulted for diagnosis and treatment of any and all medical conditions. Links to other sites are provided for information only -- they do not constitute endorsements of those other sites. © 1997- A.D.A.M., Inc. Any duplication or distribution of the information contained herein is strictly prohibited.

     
     
     

     

     

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