Erythema Nodosum 2025: Symptoms, Causes, and Effective Treatments Explained

Introduction to Erythema Nodosum

Erythema nodosum is a painful inflammatory skin disorder characterized by tender red or purple nodules, primarily appearing on the shins but occasionally on other body areas. This condition represents the most prevalent type of panniculitis, which involves inflammation of the fat layer beneath the skin. It typically arises as an immune system response triggered by infections or certain medications.

Recognizing the Symptoms

The hallmark symptom of erythema nodosum is the appearance of painful, warm, red bumps on the lower legs. These nodules can also manifest on the thighs, arms, torso, or face. The size of these lumps ranges from half an inch to four inches, and their number can vary from a few to over fifty.

Initially red, the bumps progressively turn purple, resembling bruises, and gradually flatten as they heal. The lesions usually persist for about two weeks, but new ones may continue to develop for up to six weeks.

Additional symptoms may include:

• Fever
• Fatigue
• Joint pain
• Leg pain
• Swelling of the ankles
• Enlarged lymph nodes in the chest
• Cough
• Sore throat
• Unexplained weight loss
• Abdominal pain
• Diarrhea

Understanding the Causes

In over half of cases, the exact cause of erythema nodosum remains unidentified. However, it frequently develops following infections or as a reaction to specific medications. The condition is believed to result from an exaggerated immune response to bacteria or other environmental factors.

Common causes include:

• Infections such as streptococcal throat infections and tuberculosis
• Adverse reactions to antibiotics (including sulfonamides and penicillin derivatives), salicylates, iodides, bromides, and hormonal contraceptives
• Sarcoidosis, a multi-organ inflammatory disease
• Coccidioidomycosis, a fungal lung infection
• Inflammatory bowel diseases like ulcerative colitis and Crohn’s disease
• Pregnancy-related hormonal changes
• Rarely, malignancies

Erythema nodosum predominantly affects adults aged 20 to 40, with women being six times more susceptible than men, though it can occur at any age and in both genders.

Modern Treatment Approaches

Treatment focuses on addressing the underlying cause. If a bacterial infection is responsible, appropriate antibiotic therapy is prescribed. For drug-induced cases, discontinuation of the offending medication is essential.

Symptom management includes:

• Nonsteroidal anti-inflammatory drugs (NSAIDs) such as aspirin, ibuprofen (Advil, Motrin), or naproxen (Aleve) – note that NSAIDs should be avoided in Crohn’s disease patients due to potential flare-ups
• Potassium iodide
• Oral corticosteroids for severe inflammation

Additional supportive measures involve resting with legs elevated, wearing compression stockings, and avoiding tight or irritating clothing to minimize discomfort and promote healing.

Diagnostic Procedures

Your healthcare provider will review your medical history, recent infections, and medication use before performing a physical examination of the nodules.

Diagnostic tests may include blood work to detect inflammation or infections like tuberculosis, throat cultures for streptococcal bacteria, urine analysis, chest X-rays, and stool cultures.

In some cases, a skin biopsy is performed where a small tissue sample from the affected fat layer is examined microscopically to confirm the diagnosis.

Erythema Nodosum During Pregnancy

Approximately 5% of pregnant women develop erythema nodosum, possibly linked to elevated estrogen levels. Treatment during pregnancy mirrors that for non-pregnant individuals but excludes certain medications like NSAIDs due to safety concerns.

Management typically involves bed rest, use of compression stockings, and close supervision by an obstetrician. The nodules generally resolve within a few weeks without complications.

Prognosis and Long-Term Outlook

While erythema nodosum can cause significant discomfort, it is usually benign and self-limiting. The nodules often resolve within two to four weeks but may take up to two months to completely heal. Residual bruising is common, though scarring is rare.

Some patients may experience leg pain lasting up to two years post-healing, and recurrence of the condition is possible.

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