Summary about Disease
Erythema nodosum is an inflammatory condition characterized by painful, red, and tender nodules, typically on the shins. It is a form of panniculitis, which means inflammation of the fat layer under the skin. Erythema nodosum is often a reaction to an underlying infection or inflammatory condition, but in some cases, the cause remains unknown. It is more common in women than men.
Symptoms
Painful, red or purplish nodules (bumps) on the shins are the hallmark symptom.
Nodules are usually 1-6 cm in diameter.
Nodules may also appear on the thighs, arms, or torso, but this is less common.
Fever
Fatigue
Joint pain (arthralgia), especially in the ankles and knees.
Swollen ankles
Sometimes preceded by flu-like symptoms such as cough, malaise, and runny nose
Causes
Erythema nodosum can be triggered by a variety of factors, including:
Infections: Streptococcal infections (e.g., strep throat), tuberculosis, fungal infections (e.g., coccidioidomycosis), Yersinia infections.
Medications: Sulfonamides, penicillins, oral contraceptives, NSAIDs.
Inflammatory Bowel Disease (IBD): Crohn's disease, ulcerative colitis.
Sarcoidosis: A systemic inflammatory disease.
Behçet's disease: A rare disorder that causes blood vessel inflammation.
Pregnancy
Malignancy (rare): Leukemia, lymphoma.
Idiopathic: In many cases, the cause remains unknown.
Medicine Used
Treatment focuses on managing symptoms and addressing any underlying cause. Common medications include:
Nonsteroidal anti-inflammatory drugs (NSAIDs): Ibuprofen, naproxen, or indomethacin to relieve pain and inflammation.
Corticosteroids: Prednisone may be prescribed for more severe cases, but are generally avoided for long-term use due to side effects.
Potassium iodide: Used for its anti-inflammatory properties.
Colchicine: Another anti-inflammatory medication, sometimes used for recurrent cases.
Treatment of Underlying Cause: Addressing the underlying infection or condition is crucial for resolving erythema nodosum. This could include antibiotics for bacterial infections, antifungal medications for fungal infections, or specific medications for inflammatory bowel disease or sarcoidosis.
Is Communicable
Erythema nodosum itself is not communicable. It is an inflammatory reaction, not an infectious disease. However, if the erythema nodosum is triggered by a communicable infection (e.g., strep throat), then that underlying infection is communicable, but the skin condition itself is not.
Precautions
Rest: Elevating the affected leg(s) can help reduce swelling and pain.
Compression: Compression bandages can also provide support and reduce swelling.
Avoid prolonged standing: This can worsen swelling and pain.
Cool Compresses: Applying cool compresses to the nodules can help relieve pain and inflammation.
Identify and treat underlying cause: This is crucial to prevent recurrence.
Avoid triggers: If a medication or specific factor is identified as a trigger, avoid it in the future.
How long does an outbreak last?
Typically, an outbreak of erythema nodosum lasts for 3 to 6 weeks. In some cases, it can become chronic and last for months or even years, particularly if the underlying cause is not identified and treated.
How is it diagnosed?
Diagnosis typically involves:
Physical Examination: The characteristic appearance of the nodules is often sufficient for diagnosis.
Medical History: Review of medications, recent infections, and medical conditions.
Blood Tests: To check for infections (e.g., streptococcal infection), inflammatory markers, and other potential underlying causes.
Chest X-ray: To rule out sarcoidosis or tuberculosis.
Skin Biopsy: In some cases, a biopsy of a nodule may be performed to confirm the diagnosis and rule out other conditions.
Stool Sample: To rule out Yersinia infection
Timeline of Symptoms
1. Initial Phase (Days 1-3): Often preceded by flu-like symptoms (fever, malaise, cough). 2. Development of Nodules (Days 3-7): Painful, red nodules appear, typically on the shins. 3. Peak Inflammation (Week 1-2): Nodules are most painful and inflamed. 4. Resolution Phase (Weeks 2-6): Nodules gradually flatten and become less tender. The color changes from red to purple to brownish, resembling bruises. 5. Complete Resolution (Weeks 6+): Nodules usually resolve completely within 6 weeks, leaving no scarring. However, the underlying cause must be addressed to prevent recurrence.
Important Considerations
Underlying Cause: Identifying and treating the underlying cause is essential for long-term resolution and prevention of recurrence.
Medication Side Effects: Be aware of the potential side effects of medications used to treat erythema nodosum, especially corticosteroids.
Recurrence: Erythema nodosum can recur, especially if the underlying cause is not addressed.
Differential Diagnosis: Other conditions can mimic erythema nodosum, so accurate diagnosis is important.
Pregnancy: Erythema nodosum during pregnancy requires careful management to avoid risks to both mother and fetus.
Consult a doctor: It is essential to consult a doctor for proper diagnosis and management, particularly if you experience severe symptoms or the condition does not improve with initial treatment.