Dermatology - Erythema Nodosum

Dermatology - Erythema Nodosum 
Painful nodules can occur on the lower legs as a result of erythema nodosum, an essential and prevalent pattern of acute inflammation and immunologic response of the subcutaneous fat. It is the most prevalent form of panniculitis and typically affects people in their twenties and thirties, however it can strike anyone at any time. Three to six times as many women as males experience this. Many inflammatory and granulomatous disorders, including sarcoidosis, infections, and some medications can cause this.


Arthralgia(50%), most commonly in the ankle joints, fever, malaise, and painful, sensitive lesions (often lasting a few days) accompany the condition. Depending on the cause, other symptoms may manifest.

Most commonly found on the front lower legs, these indurrated, extremely sensitive nodules range in size from 3 to 20 centimeters, do not have sharp margins, and are firmly embedded in the subcutaneous fat. They are not symmetrical and tend to be bilateral. Nodules are only palpable when they are bright red to deep crimson in color.
The skin lesions are most accurately described as erythema nodosum because they have an erythematous appearance and a nodule-like texture. With time, lesions can change shape from oval to circular or arciform, and their color from green to brown to violaceous, resembling resolving hematomas. Lesions on the knees and arms are also possible, while they manifest on the face and neck quite infrequently.

Clinical criteria provide the foundation of the diagnosis, with histology providing further support as necessary.
Panarteritis nodosa, nodular vasculitis, lymphoma, nonulcerated gumma, pretibial myxedema, and any other type of panniculitis are all on the list of possible diagnoses.
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New lesions emerge throughout the 6-week period of spontaneous remission.
No matter how many times a lesion heals, it will always leave a scar. Along with addressing the underlying ailment, treatment focuses on alleviating symptoms and providing support. In addition to anti-inflammatory medications, bed rest, compressive bandages (for the lower legs), and moist dressings can aid. It is only when the cause is established and infectious agents have been ruled out that systemic glucocorticoids are prescribed, despite their fast onset of action.