Eritema nodosum is a skin disease that causes red, painful nodules (swellings) under the skin. It usually appears on the lower legs but can also occur in other parts of the body. This disease manifests as an inflammatory response and often develops as a symptom of another illness or in response to an infection. Eritema nodosum typically heals on its own within a few weeks in most cases, but treating the underlying cause is crucial.
What Are the Causes of Eritema Nodosum?
Eritema nodosum can have many different causes. The main causes are as follows:
Infections: Various infections such as streptococcal infections, tuberculosis, yersiniosis, and viral infections can lead to eritema nodosum.
Systemic Diseases: Systemic diseases like sarcoidosis, inflammatory bowel diseases (e.g., Crohn’s disease and ulcerative colitis), and Behçet’s disease are also common causes of eritema nodosum.
Medications: Some medications, especially birth control pills, antibiotics (particularly sulfa group antibiotics), and some other drugs can trigger this condition.
Pregnancy: Pregnancy can contribute to the development of eritema nodosum due to hormonal changes.
Immune System Disorders: Problems related to the immune system and autoimmune diseases are also among the causes of eritema nodosum.
What Are the Symptoms of Eritema Nodosum?
The symptoms of eritema nodosum are as follows:
- painful, red nodules on the lower legs
- nodules are usually 1-5 cm in diameter
- fever and general fatigue
- joint pains
- nodules bruise, yellow, and heal over time
How Is Eritema Nodosum Diagnosed?
Diagnosing eritema nodosum is usually based on clinical findings and the patient’s medical history. The steps in the diagnostic process are as follows:
Clinical Evaluation: The doctor evaluates the patient’s symptoms and medical history. The presence and distribution of nodules provide important clues in diagnosing eritema nodosum.
Laboratory Tests: Blood tests are used to detect signs of inflammation and possible infections. In particular, inflammatory markers such as C-reactive protein (CRP) and erythrocyte sedimentation rate (ESR) are measured.
Biopsy: If necessary, a biopsy is taken from the affected area and examined under a microscope. A biopsy can help distinguish eritema nodosum from other skin diseases.
Imaging Tests: Imaging tests such as chest X-rays may be requested to determine the underlying cause. These tests are especially important for detecting diseases like sarcoidosis.
How Is Eritema Nodosum Treated?
The aim in treating eritema nodosum is to reduce inflammation, alleviate pain, and treat the underlying cause. Treatment options are as follows:
Treatment of the Underlying Cause: If eritema nodosum has developed due to an infection or another illness, this condition should be treated first. For example, streptococcal infection is treated with antibiotics.
Pain and Inflammation Control: Nonsteroidal anti-inflammatory drugs (NSAIDs) can be used to reduce inflammation and relieve pain. Medications like ibuprofen and naproxen are commonly used.
Bed Rest and Supportive Therapies: Due to painful nodules, patients are advised to rest and keep their legs elevated. Cold compresses can help alleviate pain.
Corticosteroids: In severe cases, oral or topical corticosteroids may be used. These drugs control inflammation by suppressing the immune system.
Potassium Iodide: In some cases, potassium iodide treatment can be used to reduce inflammation. However, this treatment method may not be effective in every patient and should be applied according to the doctor’s recommendation.
How Should Eritema Nodosum Be Managed?
Managing eritema nodosum requires a careful approach to prevent recurrence and control symptoms. Management strategies are as follows:
Regular Monitoring: Patients should regularly visit their doctor to monitor the progression of the disease and response to treatment.
Customized Treatment Plans: Treatment plans should be customized according to the patient’s symptoms and underlying causes. Medication dosages and types can be adjusted considering the response to treatment and side effects.
Lifestyle Changes: Patients are advised to adopt healthy lifestyle habits such as stress management, balanced nutrition, and regular exercise.
Education and Support: It is important for patients and their families to be knowledgeable about eritema nodosum and receive education on its management. Psychological support and patient groups can help patients cope with the disease.
Monitoring Medication Use: It is important for patients to take prescribed medications regularly and inform their doctors about any potential side effects.