Erythema Nodosum

Definition

Erythema nodosum is the name given to extremely tender lumps on the legs and sometimes the arms. They are caused by inflammation of the fat beneath the skin. The bumps look like bruises. They change color in the same way, from pink to blue to brown.
Erythema Nodosum
Erythema  Nodusum
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Causes

Erythema nodosum is thought to be a type of allergic reaction. It may be caused by:
  • Infections from a:
    • Virus
    • Bacteria
    • Fungi
  • Inflammatory conditions
  • Medications
    • Sulfa drugs and some other antibiotics
    • Iodides
    • Bromides
    • Birth control pills
    • Leukotriene modifiers
    • Proton pump inhibitors
  • Cancer
    • Lymphoma
    • Leukemia
Sometimes the cause of erythema nodosum is not known.

Risk Factors

This condition is rare. It is more common in females and young adults aged 20-30 years old. Having any of the causes listed above will only slightly increase your risk of the disorder.The risk factor for erythema nodosum is genetics.

Symptoms

Symptoms include:
  • Very tender, deep lumps, like bruises,
    • Usually located on your shins
    • May also appear on the forearms, trunk, neck, and head
  • Associated joint pain and fever and redness around the eyes

Diagnosis

You will be asked about your symptoms and medical history. A physical exam will be done, which may diagnose the problem based on a visual exam. You may be referred to a doctor that focuses on skin problems or infectious diseases.Your bodily fluids and cells may be tested. This can be done with:
  • Blood and urine samples
  • Cultures
  • PPD skin test for tuberculosis
  • Biopsy of a lesion
Images may be taken of your bodily structures. This can be done with a chest x-ray and other imaging tests.

Treatment

If a cause can be identified, it will be treated. For the nodules themselves, pain relief is all that is needed. They tend to resolve on their own in about six weeks. They will not cause scarring. Treatment options include the following:

Pain Relief

Pain relief includes:
  • Bed rest and elevation of legs
  • Wet compresses
  • Aspirin, except in children
  • Nonsteroidal anti-inflammatory drugs
  • Potassium iodide

Steroid Treatment

This may be necessary in severe cases.

Prevention

Some of the infectious causes can be avoided by practicing good hygiene, which includes:
  • Washing your hands often
  • Not sharing food, drinks, or utensils

RESOURCES

American Academy of Dermatology
http://www/aad.org

Family Doctor—American Academy of Family Physicians
http://www.familydoctor.org

CANADIAN RESOURCES

Canadian Dermatology Association
http://www.dermatology.ca

Health Canada
http://www.hc-sc.gc.ca

References

Erythema nodosum. EBSCO DynaMed website. Updated April 2, 2014. Accessed September 24, 2014.

Erythema nodosum. Better Health Channel website. Available at: http://www.betterhealth.vic.gov.au/bhcv2/bhcarticles.nsf/pages/Erythema%5Fnodosum?OpenDocument. Updated March 2014. Accessed September 24, 2014.

Requena L, Yus ES. Erythema nodosum. Dermatol Clin. 2008;26(4):425-438, v. Review.

Revision Information

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