Treatment Overview
Erythema Nodosum (EN) is a type of inflammation that affects the fat layer beneath the skin, typically causing tender, red, or violet-colored bumps, most often on the shins. These nodules can be painful and may be accompanied by fever, joint aches, or fatigue, turning daily activities like walking or standing into uncomfortable challenges. While the nodules themselves are usually harmless and not contagious, their sudden appearance can be alarming, and the associated joint pain can significantly affect comfort and mobility.
Treatment for EN is important to quickly relieve the pain and inflammation and, most critically, to identify and treat the underlying trigger, as EN is often a reaction to another medical condition, infection, or medication. Once the cause is found and addressed, the skin lesions usually resolve entirely. Because EN is a symptom rather than a primary disease, medication choices depend entirely on the severity of the skin symptoms and the nature of the associated health condition (Mayo Clinic, 2024).
Overview of treatment options for Erythema Nodosum
The main goals of treating Erythema Nodosum are twofold: managing the pain and inflammation of the skin lesions, and curing the underlying cause. In many instances, EN resolves naturally within two to eight weeks once the trigger is removed (such as stopping a reactive medication or clearing an infection).
Medications are typically used to control symptoms, particularly the joint pain and tenderness. For mild cases, conservative measures, such as rest, elevation, and compression wraps, may be sufficient to manage swelling and discomfort. However, for severe or persistent pain, medication is often necessary. The choice of drug class depends on whether the medication is targeting the painful symptoms or the overactive immune response causing the inflammation.
Medications used for Erythema Nodosum
The first line of defense for reducing the pain and inflammation associated with EN involves non-steroidal anti-inflammatory drugs (NSAIDs). Over-the-counter options like ibuprofen or naproxen are often effective for controlling fever, reducing joint aches, and easing the tenderness of the nodules.
When NSAIDs are insufficient or the symptoms are prolonged, doctors may prescribe oral corticosteroids. Prednisone is a common example in this class. These powerful drugs work quickly to suppress the immune and inflammatory response causing the nodules. Because corticosteroids carry potential side effects, they are typically used for the shortest possible duration to manage severe symptoms.
Additional or second-line treatments may include potassium iodide, which has been shown in some small clinical trials to relieve symptoms in chronic or persistent cases. For EN linked to underlying inflammatory conditions like Crohn’s disease or sarcoidosis, the treatment will center on drugs specific to the primary disease (e.g., immunomodulators or biologics), which indirectly resolve the EN. The pain and inflammation associated with the nodules usually begin to subside within a few days of starting treatment, though the nodules themselves may take weeks to fully flatten (American Academy of Dermatology, 2023).
How these medications work
NSAIDs reduce pain, fever, and swelling by blocking prostaglandins, chemicals that promote inflammation.
Corticosteroids act as broad immune suppressants, mimicking cortisol to rapidly decrease inflammation. By calming overactive immune cells attacking the fat tissue, they stop the formation and progression of tender nodules.
Potassium iodide may work by changing the local immune response in the skin, potentially improving the clearance of inflammation from the nodules (MedlinePlus, 2020). When the underlying cause, like a streptococcal infection, is treated with antibiotics, the trigger is killed, allowing the immune system to settle and the EN to resolve naturally.
Side effects and safety considerations
NSAIDs are generally safe for short-term use, but prolonged use risks stomach upset, ulcers, and kidney issues. Effective oral corticosteroids can cause side effects like fluid retention, mood changes, increased appetite, and insomnia. Long-term use requires careful monitoring for risks like bone density loss.
Patients with active infections or conditions like diabetes or peptic ulcers must use corticosteroids cautiously. It is essential to share all health history with a provider before starting strong anti-inflammatory medication. Patients should seek immediate medical attention for new, painful symptoms (like joint swelling) or signs of secondary infection in skin lesions (e.g., warmth, spreading redness, pus, ulceration) (National Institutes of Health, 2023).
Since everyone’s experience with the condition and its treatments can vary, working closely with a qualified healthcare provider helps ensure safe and effective care.
References
- American Academy of Dermatology. https://www.aad.org
- Mayo Clinic. https://www.mayoclinic.org
- MedlinePlus. https://medlineplus.gov
- National Institutes of Health. https://www.nih.gov
Medications for Erythema Nodosum
These are drugs that have been approved by the US Food and Drug Administration (FDA), meaning they have been determined to be safe and effective for use in Erythema Nodosum.