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Erythema Nodosum – Symptoms, Causes, Diagnosis, Treatment, Pictures

Written by Dr.Mary

Erythema Nodosumis a kind of inflammation of the skin that is usually found in a definite part of the layer of fat in the skin. This condition is also called EN, results in painful, reddish, lumps which are tender and most usually located in the front of the legs beneath the knees. These nodules or lumps of erythema nodosum vary in dimensions from 1 cm to 5 cm. These nodular swellings are caused by an unusual configuration of inflammation in the skin layer of fatty tissue.

The condition can be self-limited and can heal on its own in three to six weeks. When healing, it can leave a impermanent bruised look or an indentation which is chronic in the skin everyplace fatty layers have been injured.

There are numerous situations for the results of erythema nodosum. Normally, the areas of nodular soreness vary in size from a dime to a quarter and they can be inflamed on and off and be sensitive for a period of several weeks. They normally do resolve naturally, each one of the tiny areas of inflammation shrinking down and becoming flat rather than inflamed and raised. They leave a bruised look. Then, they spontaneously resolve totally. Other lesions may at times pop up somewhere else. This can arise for periods of weeks or months and ultimately goes away. But, erythema nodosum which is chronic can last for years in other patterns. Erythema nodosum which is chronic with recurrences which are intermittent, and can happen with or without an presents of any underlying disease.

Erythema Nodosum Symptoms

The severity as well as the types of symptoms of this skin condition varies between individuals depending on a vast variety of factors. These include general health, age, medical history as well as any type of underlying disease which is present.

Erythema nodosum normally begins as red nodules on the shins which are painful. These are lesions which are not open, draining or ulcerated but can feel warm to the touch. After approximately a week, the lesions then change as well as appear purple or blue in color, then will fade to a yellow color, very similar to a bruise. Nodules can also appear in other areas for instance buttocks, thighs, arms, as well as ankles. Other symptoms can include malaise, joint pain or achiness, fever as well as swelling joint.

Erythema nodosum usually does not result in any complications which are serious. But, it can occur with diseases or conditions which are serious, for instance hepatitis B, streptococcus infection, tuberculosis, mononucleosis, rheumatic fever, leukemia, as well as ulcerative colitis.

Symptoms of these diseases can include sore throat, fever, fatigues, joint and muscle aches, abdominal pain, jaundice and diarrhea.

Erythema nodosum is most common in females between the ages of 20 and 30, but can occur in anyone.


Erythema Nodosum Causes

Erythema nodosum can occur in association with other conditions or as an isolated condition. In approximately half of the cases, the precise cause is unknown. Some cases can be linked with the following:

Infections – Some of the most common ones are

  • Most common – streptococcus
  • Cat scratch disease
  • Coccidioidomycosis
  • Chlamydia
  • Histoplasmosis
  • Hepatitis B
  • Mononucleosis (EBV)
  • Leptospirosis
  • Mycoplama
  • Mycobacteria
  • Psittacosis
  • Syphilis
  • Tularemia
  • Tuberculosis
  • Yersinia


Sensitivity to medications, including

  • Amoxicillin and other penicillins
  • Sulfonamides
  • Sulfones
  • Oral contraceptives
  • Progestin
  • Other antibiotics

Other associated conditions include leukemia, lymphoma, Sarcoidosis, rheumatic fever, Bechet’s disease, and ulcerative colitis.

Erythema Nodosum Diagnosis

Normally, erythema nodosum is usually a straightforward, very unassuming diagnosis for a physician to make merely by examining the individual and noticing the usual almost hard region of elevated soreness which is red alongside areas that have had resolved lesions, that could display a bruised look. It isn’t a challenging diagnosis or conclusion for any experience physician. It doesn’t normally need other tests.

There are times when a biopsy is completed to confirm the diagnosis, for instance, if an individual has a remote, single region and the physician was not able to diagnose centered on the look. The biopsy of the layers of skin tissue which are deeper may provide the evidence that it is indeed erythema nodosum. These layers should display the precise inflammation of fatty layers.

Erythema Nodosum Treatment

After diagnosing an individual with erythema nodosum, the physician will attempt to identify the probable cause, such as infection, medical condition, or medication. The physician can order diagnostic test such as blood work, throat culture or chest x-ray. If there is an underlying cause identified, then the physician will treat it appropriately – for example, discontinuing a medication, treating a health problems or prescribing antibiotics for an infection.

Once those treatment and investigations are under way, the healthcare provider can try the following to make the individual comfortable:

  • Restriction of any physical activity or bed rest – especially during acute pain
  • Anti-inflammatory medications such as aspirin or ibuprofen
  • Potassium iodide – to heal nodules
  • Steroids – either oral form or injected directly into the lesions
  • Colchicine – reduces inflammation
  • Gentle heat like a soapy warm wash cloth held on the region for thirty minutes 3 to 4 times each day can help speed up the process of healing
  • The goal of any treatment of erythema nodosum is to relieve any pain and discomfort of the skin nodules until they resolve, normally within a couple of weeks.

Treatment must be customized for the particular individual and conditions present. It is very important to note that erythema nodosum, while painful and very annoying, does not threaten internal organs and the long-term outlook is generally very good.

Erythema Nodosum Pictures

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