What Is Erythema Nodosum

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

Erythema nodosum may occur with sensitivity to certain medications, including: antibiotics including amoxicillin and other penicillins, sulfonamides, sulfones, birth control pills, and progestin. 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 an inch across. Within a few days, they may become purplish in color. Over several weeks, the lumps fade to a brownish, flat patch.

Erythema nodosum (EN) is a skin condition in which red bumps (nodules) form on the shins. Less commonly, the nodules form on other areas of the body such as the thighs and forearms.[1][2] The lesions begin as firm, hot, red, painful lumps and progress to a purplish color.[1] EN is a type of inflammatory disorder affecting the layer of fat under the skin (panniculitis).[2][3] Other symptoms that may accompany the skin findings include the following: fever, a general feeling of being ill. joint aches, and swelling of the affected area.[1] In many cases, EN is presumed to be a delayed reaction to antigens associated with various infections, drugs, and certain systemic diseases.[3] In some cases, however, EN has no identifiable cause (idiopathic); in these cases, clinical follow-up is needed to rule out certain conditions including inflammatory bowel disease, sarcoidosis, lymphoma, and Behcet’s disease.[3] Treatment may include rest, nonsteroidal anti-inflammatory drugs (NSAIDS), steroids, hot or cold compresses, potassium iodide solution, and supportive bandages or compression stockings.[1][2] Symptoms usually resolve within six weeks, but EN may become a chronic disorder lasting for months and, occasionally, for years.[1][2] Approximately 30% cases of idiopathic EN may last more than 6 months.[4]

Types of Erythema Nodosum:

1. Classic Erythema Nodosum: This is the most common type and involves painful red nodules on the shins.

Causes of Erythema Nodosum:

1. Infections: Infections like strep throat, tuberculosis, or fungal infections can trigger erythema nodosum.
2. Medications: Certain drugs, like antibiotics or birth control pills, can lead to this condition.
3. Autoimmune Disorders: Conditions like Crohn’s disease or sarcoidosis can cause erythema nodosum.
4. Pregnancy: Some women develop it during pregnancy.
5. Inflammatory Bowel Disease: This includes conditions like Crohn’s disease and ulcerative colitis.
6. Behcet’s Disease: A rare condition causing inflammation in blood vessels.
7. Cancer: In some cases, cancer, especially leukemia, can be a trigger.
8. Stress: Emotional stress can sometimes lead to erythema nodosum.
9. Hormonal Changes: Hormonal fluctuations, like those during menstruation, can play a role.
10. Viral Infections: Infections like mononucleosis or hepatitis can be a cause.
11. Sarcoidosis: This is a rare condition where abnormal collections of inflammatory cells form in the body.
12. Asthma: Some people with asthma may develop erythema nodosum.
13. Streptococcus Infections: Strep infections, like strep throat, can trigger it.
14. Cat Scratch Disease: An infection caused by cat scratches or bites.
15. Syphilis: A sexually transmitted infection.
16. Yersinia Infections: Infections caused by certain bacteria.
17. Crohn’s Disease: An inflammatory bowel disease.
18. Ulcerative Colitis: Another type of inflammatory bowel disease.
19. Tuberculosis: A bacterial infection affecting the lungs.
20. Fungal Infections: Infections caused by fungi.

Symptoms of Erythema Nodosum:

1. Painful Red Bumps: These are the hallmark symptom, usually found on the shins.
2. Swelling: The bumps can be swollen and warm to the touch.
3. Fever: Some people may develop a fever.
4. Fatigue: You might feel more tired than usual.
5. Joint Pain: Pain in the joints, like the knees or ankles.
6. General Discomfort: You might feel unwell or under the weather.
7. Bruising: Sometimes, the bumps can turn into bruises.
8. Weight Loss: In severe cases, weight loss can occur.
9. Malaise: A general sense of discomfort or unease.
10. Redness: The skin around the bumps can be red and irritated.
11. Tender to Touch: The bumps can be painful when touched.
12. Lethargy: Feeling extremely tired.
13. Loss of Appetite: You might not feel like eating.
14. Cough: If associated with a respiratory infection.
15. Swollen Lymph Nodes: In some cases, lymph nodes may become enlarged.
16. Nausea: Feeling sick to your stomach.
17. Abdominal Pain: If related to an underlying condition like Crohn’s disease.
18. Mouth Ulcers: In Behcet’s disease-related cases.
19. Eye Inflammation: In some autoimmune-related cases.
20. Breathing Difficulties: If related to an underlying lung condition.

Diagnostic Tests for Erythema Nodosum:

1. Physical Examination: Your doctor will examine the red bumps on your shins.
2. Blood Tests: These can help identify infections or underlying conditions.
3. Skin Biopsy: A small sample of skin may be taken for examination.
4. Chest X-ray: To check for tuberculosis or sarcoidosis.
5. Throat Swab: To test for strep throat.
6. Tuberculin Skin Test: To rule out tuberculosis.
7. Stool Tests: To check for infections or gastrointestinal issues.
8. Ultrasound: For detecting abdominal abnormalities.
9. CT Scan: To get a detailed view of internal organs.
10. Sputum Culture: To identify respiratory infections.
11. ANA Test: To check for autoimmune diseases.
12. C-reactive Protein Test: To measure inflammation.
13. Erythrocyte Sedimentation Rate (ESR): Another test for inflammation.
14. Hormone Tests: If hormonal changes are suspected.
15. Chest MRI: For a more detailed look at chest abnormalities.
16. Biopsy of Affected Organs: In cases of sarcoidosis or other organ involvement.
17. Stool Culture: To rule out bacterial infections.
18. Thyroid Function Tests: If thyroid issues are suspected.
19. Joint Fluid Analysis: For joint pain evaluation.
20. Liver Function Tests: To assess liver health.

Treatments for Erythema Nodosum:

1. Addressing Underlying Cause: Treatment often involves managing the underlying condition, such as infections or autoimmune diseases.
2. Rest: Adequate rest can help the body heal.
3. Pain Relief: Over-the-counter pain relievers like ibuprofen or acetaminophen can ease discomfort.
4. Elevate Legs: Keeping your legs elevated can reduce swelling.
5. Compression Stockings: These can also help with swelling.
6. Cold Compresses: Applying cold packs can soothe inflammation.
7. Corticosteroids: In severe cases, your doctor may prescribe corticosteroid medications.
8. Immunosuppressants: For autoimmune-related cases.
9. Antibiotics: If an infection is the cause.
10. Surgery: In rare instances, drainage of the bumps may be necessary.
11. Topical Steroids: Creams or ointments for localized treatment.
12. Wound Care: Proper wound care can prevent infection.
13. NSAIDs: Nonsteroidal anti-inflammatory drugs can reduce pain and inflammation.
14. Heat Therapy: Applying heat can relieve pain.
15. Physical Therapy: Helpful for joint pain and mobility.
16. Behavioral Therapy: To manage stress in stress-related cases.
17. Anti-inflammatory Diet: A diet rich in anti-inflammatory foods may help.
18. Avoiding Trigger Medications: If a medication caused it, your doctor will change your prescription.
19. Moisturizers: For dry and irritated skin.
20. Lifestyle Changes: Quitting smoking and managing chronic conditions can prevent recurrence.

Drugs for Erythema Nodosum:

1. Ibuprofen: An over-the-counter pain reliever.
2. Acetaminophen: Another OTC pain medication.
3. Prednisone: A common corticosteroid.
4. Colchicine: Used in some inflammatory conditions.
5. Azathioprine: An immunosuppressant.
6. Methotrexate: Another immunosuppressant.
7. Dapsone: Sometimes prescribed for its anti-inflammatory properties.
8. Sulfasalazine: Used in inflammatory bowel diseases.
9. Potassium Iodide: In some severe cases.
10. Thalidomide: Rarely used due to side effects.
11. Antibiotics: If the cause is bacterial.
12. Oral Contraceptives: If hormonal fluctuations are suspected.
13. Tuberculosis Medications: For tuberculosis-related cases.
14. Anti-TNF Medications: In autoimmune-related cases.
15. Cyclosporine: Another immunosuppressive drug.
16. Interferon-Gamma: Used in some infections.
17. Antiviral Medications: For viral infections.
18. Hormone Therapy: In pregnancy-related cases.
19. Mouthwash and Eye Drops: For Behcet’s disease-related cases.
20. Anti-Inflammatory Creams: Topical steroids for skin relief.

Conclusion:

Erythema nodosum may sound complicated, but it’s essentially painful red bumps on the shins caused by various underlying factors. Proper diagnosis, treatment, and medication can help manage this condition effectively. If you experience any of the symptoms mentioned, consult a healthcare professional for guidance and care.

 

Disclaimer: Each person’s journey is unique, treatment plan, life style, food habit, hormonal condition, immune system, chronic disease condition, previous medical  history is also unique. So always seek the best advice from a qualified medical professional or health care provider before trying any treatments to ensure to find out the best plan for you. This guide is for general information and educational purposes only. If you or someone are suffering from this disease condition bookmark this website or share with someone who might find it useful! Boost your knowledge and stay ahead in your health journey. Thank you for giving your valuable time to read the article.

References