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Erythema nodosum is a fairly uncommon, but distinctive, clinical syndrome. It consists of a reaction in the skin and deeper tissues that almost always occurs on the shins.
Incidence; Causes & Development
It is more common in women than in men.
The real significance of erythema nodosum lies in the possibility of a serious underlying disease. Although in some cases no such underlying cause is found, most are associated with either a drug that has been taken, an inflammatory condition elsewhere in the body, or an infection.
Drugs that can cause erythema nodosum include penicillin (in all its forms), sulfa drugs, and oral contraceptives. The disease's association with oral contraceptives and sulfa, a drug component that is commonly used to treat urinary tract infections, may be why it is seen more frequently in women.
Sarcoid, an inflammatory condition of unknown cause that can affect almost any organ, and inflammatory bowel disease (cause also unkown) may both also be associated with erythema nodosum.
Finally, all kinds of infections, ranging from the common, such as strep throat, to the uncommon, such as coccidioidomycosis (a fungal disease mostly seen in the southwestern U.S.), may be associated with erythema nodosum. Chlamydia, tuberculosis, and other bacterial and fungal infections may also be associated with erythema nodosum, but fungal infections involving only the skin, such as athlete's foot, are not.
Erythema nodosum is not an allergic reaction to these conditions or drugs, nor does it contain any infectious organisms such as tuberculosis bacilli or strep germs. Why some people develop these odd reactions to illness, drugs, or infections that many of us have or take, is completely unknown.
Signs & Symptoms
Usually, several tender red nodules are present on both legs. There may be fever, aching joints, and fatigue. Over a period of weeks, the nodules become less tender, turn purplish, and heal without scarring. Rarely, they recur periodically.
Prognosis
Since the erythema itself is not dangerous and heals without treatment, doctors will spend most of their time and effort trying to rule out an underlying cause.
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Recommendations and treatments for Erythema Nodosum: | | | | | Drug |  Antibiotics | Some experts suggest treating all cases with penicillin (if penicillin was not the underlying cause), because strep infection is frequently the underlying condition. |
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KEY | | Likely to help |
GLOSSARY
Chlamydia
A sexually-transmitted disease that is often without symptoms. Some females experience a white vaginal discharge that resembles cottage cheese, a burning sensation when urinating, itching, and painful intercourse. A clear watery urethral discharge in the male probably is a chlamydia infection.
Coccidioidomycosis (Valley Fever)
A disease caused by inhaling spores of the fungus Coccidioides immitis. It starts out as a respiratory illness and may progress to a persistent infection; disseminated coccidioidomycosis is the most severe form and is often fatal. Anyone who is present near dust-producing activities where soil or other materials contaminated with C. immitis are present can get this disease if enough spores are inhaled. Symptoms: First the lungs are infected, possibly producing no symptoms at all or perhaps a fever, chills, and cough. This infection may heal completely, or result in other complications. Approximately 1-in-1000 cases will progress to the disseminated form, leading to lesions in the lung and abscesses throughout the body. These abscesses tend to form in the subcutaneous tissues, skin, bone and the central nervous system (the brain and spinal cord).
Erythema Nodosum
Acute inflammation of skin with red nodules.
Streptococcus (Strep)
A genus of gram-staining chain-forming cocci bacteria. Some are responsible for common and potentially serious human infections, ranging from scarlet fever and strep throat to bacterial endocarditis and pus pockets. Most of the disease-potential streps are also a normal part of the skin, mouth and upper respiratory flora.
Syndrome
A medical condition characterized by a collection of related symptoms (what the patient feels) and signs (what a doctor can observe or measure).
Tineas (Athletes Foot, Athlete's Foot, Pityriasis Versicolor, Ringworm, Tinea Pedis, Tinea Versicolor)
A dermatomycosis; any number of skin fungus infections, such as ringworm, athlete's foot (Tinea pedis), and so forth. It is generally slow to acquire and hard to get rid of. Tinea Versicolor is a chronic skin fungus, often without symptoms... except the light skin splotches of infected surfaces that don't tan. It seems easily transmitted from one part of the body to another or one person to another. It is also called Pityriasis Versicolor.
Tuberculosis
Also known as TB, Consumption or "The White Plague", tuberculosis is an infectious disease caused by a bacterium called Mycobacterium tuberculosis, usually affecting the lungs but possibly also the brain, kidneys and bones. Patients may at first be symptom-free or experience a flu-like illness. In the secondary stage, there might be a slight fever, night sweats, weight loss, fatigue and various other symptoms, depending on the part of the body affected. Tuberculosis of the lung is usually associated with a dry cough that eventually leads to a productive cough with blood-stained sputum. There might also be chest pain and shortness of breath.
Urinary Tract (UT)
The kidneys and the lower urinary tract, which includes the ureters, bladder, and urethra.
Last updated: Jul 19, 2008
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