What is Erythema Nodosum?
Round, reddish bumps develop in a condition called Erythema nodosum (EN). The fatty layer of the skin is primarily affected in EN. That is why this is also considered to be a form of panniculitis. The common appearance of EN is in front of the legs, specifically on both shins. This is also an idiopathic condition whose cause yet remains unknown but more recently linked to staphylococcal infections and sarcoidosis.
People in the United States aging 18-34 commonly develop erythema nodosum. It has also been additionally found that the female population is more affected with this condition with a current ratio of 1:4. The prevalence of EN actually varies according to geographical location with 2.4 cases per 10,000 in England alone.
There’s no reason to fret though because the nodules associated with EN would just resolve within 6 weeks or so without any medical interventions. Just so you know there are actually two different types of EN and these include:
Acute – This is the common type of EN in pediatric patients and is usually associated with staphylococcal infections.
Chronic – As compared to the former, chronic EN is less common. This type of EN is classified as a septal panniculitis and is sometimes referred to as sub-acute nodular migratory panniculitis of Piñol and Vilanova or erythema nodosum migrans.
Erythema Nodosum Symptoms
There may be a series of symptoms involved in erythema nodosum before the tender, red bumps begin to show up. People with EN are likely to experience the following clusters of symptoms:
Flu-like manifestations – Initially, one may feel as if suffering from a bout of flu. Feeling of general weakness may be noted. During this time, other symptoms may also be present including:
- Painful and swollen joints
- Loss of appetite
- Muscle pains
- Weight loss
These symptoms may be felt within a few weeks (or to some within a month) and those tiny, red, bumps would then begin to surface.
Appearance of tender bumps – After several weeks of feeling generally unwell, painful nodules would then begin to appear. The red bumps, usually measuring around 2-6 centimeters in diameter, have no defined margins and may be found anywhere in the body. However, you would find the majority of these on the shins. The nodules would typically resolve within a week but would also sooner be replaced with new ones. About 50 nodules would develop during the entire course of the disease. As soon as the nodules begin to heal, these would seem to appear like bruises turning their color from blue to yellow. You should allow at least several weeks for the nodules to fully resolve.
Erythema Nodosum Causes
Nearly half of the erythema nodosum cases are without a specific cause. Often, this is referred by physicians as idiopathic erythema nodosum. Though this is oftentimes considered to be an isolated case, there are certain instances that this can be triggered by certain factors which may generally involve hypersensitivity of the immune system. More specifically, EN may be triggered by the following conditions:
Streptococcal infection – This is considered to be the leading cause of erythema nodosum in both children and adults. A common form of streptococcal infection, a type of bacterial infection, is sore throat.
Medication – There are medications that would trigger EN and these include the use of oral antibiotics as well as contraceptive pills.
Inflammatory Bowel Disease (IBD) – People with IBD like ulcerative colitis and Crohn’s disease are also at risk for developing EN.
Pregnancy – Although this has not been fully understood, getting pregnant has been found to trigger EN.
Tuberculosis – This lung infection caused by M. tuberculosis may also be considered to be among the triggers of erythema nodosum.
Sarcoidosis – The lymphs and the lungs are primarily affected by an inflammatory condition called sarcoidosis. This is associated with the accumulation of tiny lumps of cells on the previously mentioned organs. Sarcoidosis is yet another trigger for EN.
Cancer – Certain types of cancer including leukemia and lymphoma may also be factors that trigger EN.
Other infections that are likely to lead to EN include:
- Yersinia enterocolitica
- Mycoplasma pneumonia
Erythema nodosum may be diagnosed from its physical appearance. Doctors would closely examine the nodules. Nevertheless, when they’re unsure of its characteristics they would run further tests such as:
Blood test – This would usually detect the presence of any inflammatory process.
Chest X-ray – This is primarily done to rule out the possibility of sarcoidosis or tuberculosis.
Biopsy – When all diagnostic procedures seem to be futile, a biopsy may be indicated. Biopsy involves taking a sample coming from the nodules which would then be sent to the lab for further analysis. Septal panniculitis would usually be revealed during biopsy.
Erythema Nodosum Treatment
Treatment may not be imperative in erythema nodosum. However, due to the uncomfortable symptoms that may be present in EN, treatments would most likely be indicated including:
Non-Steroidal Anti-Inflammatory Drugs (NSAIDS) – These medications are given to alleviate pain and discomfort.
Potassium Iodide – Joint pains may be relieved with this drug though it has not been fully understood how this works. Potassium iodide is taken orally but is not considered to be a very effective form of treatment for some people.
Steroids – Inflammation will be relieved by taking steroids. Nevertheless, these are contraindicated to those who are suffering from cancer.
There are also simple remedies that would help manage the symptoms of EN. It is highly recommended that you raise your legs so as to decrease swelling and control pain. Your doctor would also prescribe you with supportive stockings. Applying cold compress would also provide pain relief. And lastly, taking enough rest would greatly improve one’s condition by speeding the healing process. It takes usually 6-8 weeks for EN to fully resolve. In rare cases, the entire course of the disease would take up to 6 months. One should not worry though because most people who previously suffered from erythema nodosum eventually recovered from it without having any complications.
Erythema Nodosum Pictures
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