Erythema nodosum – causes, symptoms, treatment

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Erythema nodosum is a disease characterized by painful red bumps under the skin. It can be caused by parasitic infections and certain medications – the way it is treated depends on the cause of erythema nodosum.

What is erythema nodosum?

Erythema nodosum is one type of erythema, an inflammatory condition that affects the fatty tissue beneath the skin. The ailment can be caused by parasitic infections and certain medications. The name of the disease comes from subcutaneous (nodular) lesions that sometimes reach several centimeters. Erythema nodosum is a condition that is largely activated in women.

Erythema nodosum – causes

Nodular erythema can be induced viral infections (hepatitis B or HIV), bacterial (tuberculosis, streptococcus, salmonella) and parasitic (especially the parasite responsible for toxoplasmosis), as well as drugs: analgesics, antipyretics, tetracyclines, sulfonamides, salicylates. When medication is the cause of erythema, it is often accompanied by erythema multiforme. Another cause of the disease may be the use of hormonal contraceptives. Erythema nodosum can also be a symptom of other diseases:

1. streptococcal infection (e.g. strep throat),
2. sarcoidozy,
3. tuberculosis,
4. toksoplasmosis,
5. venereal granuloma (chlamydial infections),
6. infectious mononucleosis,
7. inflammatory bowel diseases: ulcerative colitis, Crohn’s disease.

Certain physiological conditions can also lead to erythema nodosum:

1. stress,
2. pregnancy: end of the first and beginning of the second trimester,
3. decreased immunity,
4. fatigue,
5. not sleeping.

Symptoms of erythema nodosum

At the beginning of the disease, patients experience a general malaise, high temperature, sore throat and even diarrhea. Coughing and hoarseness are not uncommon. In addition, before the appearance of the characteristic lumps, there may be swelling and pain in the joints. At first, patients do not suspect that something disturbing is happening, because the symptoms of this ailment resemble a common cold. Over time, subcutaneous nodules begin to appear, which indicate erythema nodosum. As the disease develops, they change their color to brown and then green.

They most often attack the front surface of the shin and reach a diameter of one to several centimeters. The nodules can merge with each other, which often causes their size to reach 10 cm. They are easily felt and the skin in their place is warm and red.

The lumps in the erythema nodosum resemble bruises and, unfortunately, are painful. If they occur in the lower limb, they can even cause walking problems, so patients have to stay in bed until symptoms resolve. The cysts disappear on their own and leave no scars, but for several weeks the skin may be slightly discolored where they occur. Unfortunately, in people who have had erythema nodosum once, it may reappear.

Diagnostics of the nodular erythema

In the diagnosis of erythema nodosum, doctors recommend basic blood tests: ESR, complete blood count and serological tests for the presence of viral antigens. For the final diagnosis of the disease, a section of the nodule is taken and then subjected to a histological examination.

Treatment of erythema nodosum

Treatment of erythema nodosum is often time-consuming. They should be run by a good dermatologist. Certainly, factors that may increase the risk of the disease (outbreaks of infection and medications) should be eliminated and systemic and local therapy should be used for a long time. The therapeutic management is determined individually for each patient; this is not possible without examining the patient. Often, however, relief is provided by compresses made of 2% ichthyol solution, ichthyol ointment (5-10%), methanabolic or metindole ointment.

If there is no improvement in treatment, your dermatologist may prescribe corticosteroids.