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Erythema Nodosum – Pictures, Symptoms, Causes, Treatment

Updated on February 11, 2014

What is Erythema Nodosum?

Inflammation that occurs in the fatty layer of the skin is known as erythema nodosum. It is a form of panniculitis that is characterized by the growth of red lumps or nodules underneath the skin surface. These tender bumps most frequently appear on the area just below the knees or in the shins; although they may also develop on the forearms and thighs. Many cases of erythema nodosum are idiopathic, that is, there is no definite trigger or cause of its formation. Still, there are cases linked to varied causes, such as streptococcal infection, hepatitis B, tuberculosis and sarcoidosis. Erythema nodosum is typically self-limiting and resolves on its own within several weeks. However, it may leave an indented appearance or bruise on the affected site.

Occurrence of Erythema Nodosum

This inflammatory condition of the skin most commonly affects people who are 20 to 45 years old. About 3 out of 10,000 get this condition with cases involving females up to six times more than males. It doesn’t commonly affect children and the elderly.

Causes of Erythema Nodosum

Erythema nodosum is a reaction to hypersensitivity that usually occurs on its own. Still, there are cases that arise due to or in conjunction with other medical conditions. Some of the more common causes include the following:

  • Infections of the throat – Throat infection could be viral or bacterial in origin. But the most common cause of erythema nodosum in children as well as in adults is streptococcal infection.

  • Sarcoidoisis – This condition which causes the formation of granulomas in the lymph glands, lungs and other organs of the body could likewise trigger the development of red nodules on the subcutaneous layer of the skin. This is a common cause of erythema nodosum in adults.

  • Tuberculosis – This bacterial infection not only has an effect on the lungs, it may also give rise to erythema nodosum.

  • Pregnancy – Pregnancy can trigger erythema nodosum but usually resolves after delivery. The condition may reappear when the woman conceives again.

  • Inflammatory bowel disease – Individuals who suffer from Chron’s disease or ulcerative colitis may also experience erythema nodosum.

  • Other infections and disorders – Mononucleosis, fungal infections, Chlamydia, infection of Mycoplasma pneumonia, leukemia, rheumatic fever and Becket’s disease are also common causes.

  • Medications – Sensitivity to certain oral contraceptives, nonsteroidal anti-inflammatory drugs, sulphonamides, iodides, bromides and gold salts have been recorded to cause erythema nodosum.

Signs and Symptoms of Erythema Nodosum

Even before the appearance of red lumps on the skin, a person affected by erythema nodosum may experience malaise or feeling unwell for several weeks. Coughing, fever, stiffness, joint pain and swelling, and weight loss may also ensue. Pain in the joints and legs could continue on months after the red lumps appear.

Aside from the shins where the red nodules most commonly develop, erythema nodosum may also show itself in other parts of the body such as the thighs, arms, calves and buttocks. These round bumps have diameters ranging from 2 to 6 centimeters and can be very painful. The lump will first appear as red, hard and warm but will eventually turn squashy and resemble a bruise. It will take on a bluish hue then turn yellowish until it completely heals. Though a lump resolves in two weeks time, other red nodules could form. For this reason, the condition could bring as many as fifty nodules.

If erythema nodosum occurs with an underlying condition, other symptoms may also be manifested depending on the trigger. For instance, if the trigger is tuberculosis, the patient may also suffer from breathing difficulties and coughing aside from having the red nodules. Meanwhile, stomach pain and diarrhea could be present if the cause is inflammatory bowel disease.

Diagnosis of Erythema Nodosum

Erythema nodosum can be diagnosed by physical examination of the nodules or could be positively confirmed through a tissue biopsy from one of the lumps. The doctor may also require other procedures and tests to determine the root cause.

Treatment of Erythema Nodosum

If the condition has been confirmed, treatment will be recommended to ease the symptoms. These include:-

  • Use of pain relievers such as NSAIDs

  • Elevating the affected part

  • Getting ample rest and limiting movement

  • Use of supportive stockings or bandages for the legs

  • Application of cool compress

  • Use of steroids

Erythema nodosum will clear up within six weeks even without treatment. Though this inflammatory skin condition does not really pose a serious threat to life, it could cause a significant degree of pain and discomfort. It is also possible that it will recur. Since it is possible that the condition is just an early symptom of another health condition, it is crucial to consult a doctor whenever erythema nodosum is suspected. This is so to determine the underlying cause and begin the corresponding treatment required.

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    • SpecialK3699 profile image

      Kat Sap 2 months ago from So Cal

      I was diagnosed with Erythema Nodosum in the early 80's at the age of 24 (now 60). I injured the top of my foot in the office, after which serious swelling of the top of my foot began. Over the course of a couple of weeks, both feet swelled and I began seeing (many) nodules appear at ankle level and above, all the way up to my knees. About the size of half an olive, they covered my ankles, shins, calves and knees. The swelling of my ankles was so bad that I couldn't get my feet at a right angle in order to stand up, plus the pain was excruciating. I was let go from my job and stayed home, not knowing what was wrong, scooting around the house on my bottom because I couldn't stand up. I had to make meals for my 2 year old! Because I overused my wrists and elbows, the nodules began to appear there as well. Our Navy medical center told me I needed to see a rheumatologist, which I did and obtained the diagnosis. At the time, it was believed there were 5 triggers for this disorder, 3 of which (multiple strep infections (5), birth control pills (x 3 years) and stress (lots of it) applied to me. I wound up in a wheel chair for a little over 2 months and the nodules and swelling eventually subsided, along with the typical "bruising" where each nodule had been.

      This disorder has recurred throughout my adult life, but never to the extent that it did the very first time. However, I have always had painful lumps along my shins, along with other tender points in my body.

      Currently, I am having a flare-up and have been in pain with new nodules in my feet, mostly in, above and below, my ankles, some of which have gone away, but they aren't as red hot this time (only a couple of them are). I am out of town and not near my own medical team, so the doctor I am seeing, an internist, gave me a B12 shot, steroid shot, and NSAIDS (Diclofenac) to control the pain, although 2 pills per day is not near enough, so I am in pain and have taken extra ibuprophen to curb it. Wondering if the treatment has held off the nodules to some extent. I am resting and keeping my feet elevated as much as possible.

      Recent research indicates that this disorder can also be caused by fungal infections (I am susceptible to candida overgrowth), antibiotics and anti-inflammatories, the very medications that have been given to me over the years. I have also found that this disorder is now considered a "skin condition" and that dermatologists treat it. Is that correct? I also have been diagnosed with Fibromyalgia (also in the 80's) and am wondering about the correlation between the two.

      I am looking for specialists who have experience with this condition (in the Phoenix/Sun City area or in the Riverside, CA area). I am also looking for an online support group and wonder if someone in this community knows of such a group as I have never personally met anyone else with this disorder.

      Any helpful information is welcome. Thank you!

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