A Family Doctor’s Tale – ERYTHEMA NODOSUM
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DOC I HAVE ERYTHEMA NODOSUM
What is Erythema nodosum?
Erythema nodosum is an acute erythematous disease of the skin and subcutaneous tissues characterized by painful nodular erythemous reactions associated with a systemic disease or process.
Erythema Nodosum is more common in women than it is in men.
What causes Erythema nodosum?
50% per cent of the erythema nodosum has unknown causes .
The remainder 50 per cent has known causes as below:
1.The commonest cause is streptoccocal infections.
Other infections are:
coccideomycosis
histoplasmosis
tuberculosis
Cat scratch disease
Leptospirosis
Infectious Mononucleosis
Psittacosis
Syphilis
Chlamydia
Hepatitis B
Mycoplasma
Mycobacteria
2.Systemic diseases:
sarcoidosis
ulcerative colitis
leukemia
lymphoma
Tularemia
rheumatic fever
3.Drug reaction to antibiotics such as sulphonamides, sometimes tetracycline and
amoxillin and penicillin drugs
oral contraceptives.
progestin
sulphones
What are the symptoms of Erythema nodosum?
Erythema nodosum symptoms is acute in onset with fever and transient joint pain.
1.lesions are bright red, shiny nodules 3-4cm in diameter
2.typically found on shin(anterior tibial surfaces) but can also occur on the thighs, buttocks, arms
3.lesions can change from pink to blue to brown with appearance like a bruise
4.the lesions are painful throbbing and tender initially
5.legs may be swollen
6.lesions often symmetrical on both legs
7.scattered lesions may occured elsewhere
8.joint swelling
How is the diagnosis of Erythema nodosum made?
The diagnosis of Erythema nodosum involve
1.typical appearance of skin and mucosa
2.history of bacterial and medical causes.
3.Full blood count showed raied white blood cells and Erythrocytes Sedimentation Rate (ESR)
4.Antistreptococcal titers raised in streptococcal cases
5. mantoux test for tuberculosis
6.Chest X rays showed hilar nodes and evidence of sarcoidosis or tuberculosis
7. Throat swabs for streptococcus
8. Most important is a punch biopsy of a nodule which will confirm the illness under the microscope
What are the complications for Erythema nodosum ?
1.heart valve and kidney disease from streptococcus infection (rheumatic fever)
2. Underlying conditions such as lymphoma , leukemia, sarcoidosis, tuberculous, ulcerative colitis, can be dangerous and fatal
What is the treatment for Erythema nodosum?
Treatment for Erythema nodosum :
1.bed rest and fluids
2.legs with nodules relieved of pressures by elevation with foot rests
3.treat infections with antibiotics
4.Hot or cold compresses to help reduce discomfort
5.analgesis and non steroidal anti-inflammatory drugs for pain and swelling
6.treat underlying cause and remove offending drug or radiation
7.Potassium iodide (SSKI) solution to clear up the nodules.
What is the prognosis of Erythema nodosum?
generally good with proper treatment. It is not dangerous.
However the condition usually go away within about 6 weeks, but may recur.
Tagged with: Bacterial • Conditions and Diseases • Erythema nodosum • Health • Infectious Diseases • Lymph node • Rheumatic fever • Streptococcal
Filed under: Medical case Studies
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