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Erythema Nodosum (Pictures)

Erythema nodosum is an important acute inflammatory/immunologic reaction pattern of the panniculus characterized by the appearance of painful nodules on the lower legs and caused by multiple and diverse etiologies. The nodules may occur anywhere there is fat under the skin, including the thighs, arms, trunk, face, and neck.

The age of onset is from 15 to 30 years, but age distribution is related to etiology. Erythema nodosum is three times more common in females than in males. Etiologic associations include infections, drugs, and other inflammatory/granulomatous diseases, notably sarcoidosis.

Causes of Erythema Nodosum

There are many causes of erythema nodosum. The most common cause of erythema nodosum is medications, especially sulfa drugs and some brands of the oral contraceptive pill. If the pill is changed, the erythema nodosum resolves. Apart from drugs, infections are the largest cause of erythema nodosum, including 'Strep" throat, TB and others.

Signs and symptoms of Erythema Nodosum

The following are the most common symptoms of erythema nodosum. However, each individual may experience symptoms differently:

• raised bruises on shins
• fever
• joint pain
• enlarged lymph nodes in chest

Young adults are particularly susceptible to erythema nodosum

Diagnosis

Diagnosis rests on clinical criteria, may be supported by histopathology. A biopsy (removal of tissue for examination under a microscope) of a bump can usually confirm the diagnosis. However, the exact cause can not always be identified.

Treatment of Erythema Nodosum

• The most effective treatment is to remove the cause. Sometimes no cause is found, and complete resolution takes four to six weeks.
• An aspirin like drug called Indocin often improves the condition. This medication should be taken three times a day with food or Maalox.
• A course of potassium iodide is often effective in clearing it.
• Anti-inflammatory Treatment Salicylates, NSAIDs.

Prevention of Erythema Nodosum

• 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.