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, like strep throat, to the uncommon, like 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.
I have used the word “associated” because 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. 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. Some experts suggest treating all cases with penicillin (if penicillin was not the underlying cause), because strep infection is frequently the underlying condition.
Signs, symptoms & indicators of Erythema Nodosum
Fatigability
Occasional/frequent unexplained fevers
Joint pain/swelling/stiffness
History of/having tender red leg nodules
Risk factors for Erythema Nodosum
Pharyngitis
Strep throat can cause Erythema Nodosum
Erythema Nodosum suggests the following may be present
Autoimmune Tendency
Yersinia enterocolitica can be responsible for autoimmune disorders (such as arthritis, enterocolitis, erythema nodosum, Reiter’s syndrome and iritis) where patient serum contains antibodies to thyroid cytoplasm and plasma membrane.
Pharyngitis
Strep throat can cause Erythema Nodosum
Recommendations for Erythema Nodosum
Probiotics / Fermented Foods
If Y. enterocolitica is involved in the initiation (and continuance) of EN, then using a probiotic may help oppose this dysbiosis.
Conventional Drugs / Information
Treatments for erythema nodosum include antiinflammatory drugs, and cortisone by mouth or injection. Colchicine is sometime used effectively to reduce inflammation. Treatment must be customized for the particular patient and conditions present. It is important to note that erythema nodosum, while annoying and often painful, does not threaten internal organs and the long-term outlook is generally very good.
Key
| Weak or unproven link |
| Strong or generally accepted link |
| Proven definite or direct link |
| Likely to help |
Glossary
Erythema Nodosum
Acute inflammation of skin with red nodules.
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.
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.
Autoimmune Disease
One of a large group of diseases in which the immune system turns against the body's own cells, tissues and organs, leading to chronic and often deadly conditions. Examples include multiple sclerosis, rheumatoid arthritis, systemic lupus, Bright's disease and diabetes.
Arthritis
Inflammation of a joint, usually accompanied by pain, swelling, and stiffness, and resulting from infection, trauma, degenerative changes, metabolic disturbances, or other causes. It occurs in various forms, such as bacterial arthritis, osteoarthritis, or rheumatoid arthritis. Osteoarthritis, the most common form, is characterized by a gradual loss of cartilage and often an overgrowth of bone at the joints.
Iritis
An inflammation of the iris of the eye.
Serum
The cell-free fluid of the bloodstream. It appears in a test tube after the blood clots and is often used in expressions relating to the levels of certain compounds in the blood stream.
Antibody
A type of serum protein (globulin) synthesized by white blood cells of the lymphoid type in response to an antigenic (foreign substance) stimulus. Antibodies are complex substances formed to neutralize or destroy these antigens in the blood. Antibody activity normally fights infection but can be damaging in allergies and a group of diseases that are called autoimmune diseases.
Thyroid
Thyroid Gland: An organ with many veins. It is at the front of the neck. It is essential to normal body growth in infancy and childhood. It releases thyroid hormones - iodine-containing compounds that increase the rate of metabolism, affect body temperature, regulate protein, fat, and carbohydrate catabolism in all cells. They keep up growth hormone release, skeletal maturation, and heart rate, force, and output. They promote central nervous system growth, stimulate the making of many enzymes, and are necessary for muscle tone and vigor.
Cytoplasm
The inner substance of a cell contained within the cell membrane other than the nucleus.