Erythema nodosum, or nodular erythema, is an inflammatory skin condition that causes soft, nodular, and painful inflammatory reactions in the subcutaneous fatty tissue. Nodular erythema occurs on the front of the lower legs. Mainly women are affected by erythema nodosum. Nodular erythema is often, due to similar complaints and symptoms, confused by doctors with erysipelas and treated incorrectly.
What is erythema nodosum?
In erythema nodosum, multiple nodular foci of inflammation develop on the lower legs – rarely on other parts of the body, such as the buttocks. They can vary in size and merge into one another, depending on the severity of the nodular erythema. The inflammation affects the subcutaneous fatty tissue. The tissue becomes inflamed for various reasons, which include bacterial infection, allergies, hormonal fluctuations or infected injuries. Erythema nodosum is a very painful disease, but in many cases it heals spontaneously without any treatment. Initially, skin lesions resembling healing hematomas remain. It is possible that erythema nodosum develops into a chronic disease triggered by another underlying disease. However, nodular erythema also occurs as an isolated disease.
Causes
Erythema nodosum knows a number of very different causes. Superficially, there is an inflammation of the skin. However, the trigger for this in nodular erythema ranges from a bacterial infection in a completely different area of the body to an isolated outbreak with no other triggers. Apart from isolated nodular erythema, the skin can be assumed to be reacting to some other impairment of the body through the inflammation. Erythema nodosum is often seen in association with tonsillitis or intestinal inflammation. An allergic reaction or hormonal fluctuations due to taking the contraceptive pill and during pregnancy also lead to the occurrence of erythema nodosum. In favor of its characterization as an overreaction is the fact that in most cases of nodular erythema it also heals again without problems.
Symptoms, complaints, and signs
Erythema nodosum is noticeable by the characteristic nodules in the subcutaneous fatty tissue. The growths are very painful on pressure, indistinctly circumscribed, and palpable from the outside. They reach a size of several centimeters and may become a larger nodule in the course of the disease. The surrounding tissue is reddened and overheated; when several growths merge, it often takes on a dark red color and is very sensitive to pressure. The color of the nodules changes from a reddish-purple tone to a yellowish-green color as the disease progresses. The inflammatory nodules occur predominantly on both lower legs, especially around the tibial edges and ankle joints. In severe cases, additional nodules form on the knees, thighs, arms and elbows. Accompanying the external features, erythema nodosum is manifested by an increasing feeling of illness. Those affected often feel fatigued and tired, and suffer from fever or joint and muscle pain. In the later stages, circulatory problems such as sweating or palpitations may also occur. If the nodules are scratched open, an infection may develop. Thanks to the noticeable signs and symptoms, nodular erysipelas can be diagnosed quickly and then treated in a targeted manner.
Diagnosis and course
Erythema nodosum is unproblematic in diagnosis because of its typical nodularity, reddened skin, and usually limited appearance to the front of the lower legs. To clarify another underlying disease, infections such as tonsillitis or intestinal diseases are inquired about and, in case of doubt, determined more precisely if the symptoms are unclear. A possible pregnancy should be clarified already because of the medical treatment of erythema nodosum. Usually, nodular erythema develops within a few days and then persists for a period of two to three weeks. Eventually, the symptoms subside, still leaving hematomas as secondary damage from the skin inflammation. During this period, a patient may feel fatigued and feverish. He tires easily and is less able to perform due to the nodular erysipelas.The painful skin lesions of erythema nodosum impair mobility and generally cause physical and psychological debilitation.
Complications
Erythema nodosum also called nodular erysipelas belongs to the inflammatory skin diseases, which often affect women. Soft nodules that are visibly reddened develop in the subcutaneous fatty tissue of the front of the lower legs. If the affected areas swell, they begin to hurt intensely. The symptom is often confused with erysipelas. Affected persons should therefore consult a doctor at the first signs. The disease trigger can be a bacterial infection or an isolated outbreak, whereby the skin reacts by means of inflammation to an endogenous accompanying symptom. These include intestinal diseases, allergies, hormonal fluctuations, oral contraceptives, tonsillitis, and pregnancy. In most cases, few complications develop, but the symptom may become chronic if another underlying disease or overreaction is present. If erythema nodosum is not treated in time, not only the triggering cause worsens. The extremely pressure-sensitive nodules can swell to palm size under the skin surface and cause hematomas in addition to severe skin redness. The legs ache, feel overheated, bloated and heavy. Some sufferers experience episodes of fever and a significant drop in performance. The medical countermeasures allow the nodular erysipelas to subside relatively free of complications in about three weeks if recognized early, and at the same time treat the causative disease or infection. If the therapy is cortisone-based medication, the existence of pregnancy should be ruled out beforehand.
When should you go to the doctor?
If nodules form on the skin that are perceived as painful or uncomfortable, a doctor should be consulted. If the discomfort persists or occurs repeatedly, it is advisable to consult a doctor. If inflammatory symptoms develop, a visit to the doctor should also be made. When pus forms and open wounds develop, germs can enter the organism, leading to further illnesses. Since in severe cases there is a risk of blood poisoning, a doctor should be consulted as soon as a feeling of indisposition or increased body temperature develops. If body fluids leak from the nodes, this is considered unusual and should be clarified. If the nodes increase in size, a doctor should be contacted. If emotional or psychological problems set in, a doctor is needed. Persistent mood swings, a depressed state of mind or social withdrawal are considered worrisome and should be discussed with a physician. If the affected person suffers from pain, swelling or joint problems, he or she needs a doctor. If there is decreased movement or faulty posture due to the symptoms, a doctor’s visit is necessary. There is a threat of permanent damage, which should be prevented in time. If there is a feeling of permanent warmth in the affected regions, it is advisable to consult a doctor.
Treatment and therapy
Treatment is not mandatory for erythema nodosum, but should still be given because of the considerable pain. Erythema nodosum usually responds well to anti-inflammatories. For faster healing of the skin lesions, the use of a cortisone-containing ointment in external application is helpful. Oral administration of cortisone preparations can also shorten the course of the disease. Antibiotics are used if the underlying disease is a bacterial infection such as tonsillitis. If it heals, the nodular erythema also improves in immediate connection. Since erythema nodosum affects the lower legs, any excessive stress on the legs should be avoided during the disease. Patients with nodular erythema find clothing that covers the lower legs painful. The areas are hot due to inflammation and do not require additional stress from bandages or tight-fitting clothing. Only when the symptoms subside can elastic bandages be applied to erythema nodosum. This promotes regression of the hemotomas and protects against unwanted pressure pain during the decay phase of nodular erythema.
Outlook and prognosis
The prognosis of erythema nodosum is favorable. In a large number of affected individuals, no therapy is necessary.The changes in the skin’s appearance heal spontaneously and without the need for treatment. Within a few days, there is usually already an improvement, until complete freedom from symptoms is achieved after a few weeks. In the case of complaints such as pain, medications are administered to alleviate the symptoms. They support the healing process and lead to an improvement in health. In addition, ointments are administered to promote regression of the skin lesions. Patients with a weakened immune system should undergo medical treatment for a good prognosis. There is a risk that the pathogens will spread and existing symptoms will increase. Moreover, without support, the organism is often not sufficiently capable of preventing the bacteria from multiplying and killing them with its own forces. In order to prevent a further deterioration of the health condition and thus a worsening of the prognosis, help should be sought. If complications occur, this can lead to an impaired chance of recovery. Mobility is restricted for the duration of the disease. Emotional problems may occur, leading to mental disorders in severe cases. If this course becomes apparent, unwanted delays may occur.
Prevention
Erythema nodosum as a spontaneous overreaction to another underlying disease is almost impossible to prevent. The situation is different for patients who react with nodular erythema to contact with an allergen. If the triggering factor of erythema nodosum is known, it should be avoided for the future.
Follow-up
In most cases of erythema nodosum, very few measures and options for aftercare are available to the affected person. In this disease, early detection with subsequent treatment must be carried out in the first place. This is the only way to prevent further complications or discomfort, since this disease cannot heal itself. Therefore, in the case of erythema nodosum, the early detection of the disease is of primary importance. The earlier it is detected, the better the further course of the disease usually is. The treatment itself is usually carried out by taking medication, whereby antibiotics are also used. The person affected should ensure that they take the medication regularly and in the correct dose. Antibiotics should not be taken together with alcohol, otherwise their effect is significantly weakened. Furthermore, regular examinations by a doctor are also very important in order to detect other complaints at an early stage. Antibiotics should usually continue to be taken for some time after the symptoms have subsided. As a rule, the life expectancy of the affected person is not reduced by this disease.
What you can do yourself
Erythema nodosum generally heals within three to six weeks, even without therapy. However, nodular erythema can cause severe pain that must be treated with various medications. Sometimes remedies from naturopathy, for example calendula ointment or applications with arnica, also help. Parallel to symptomatic treatment, it is important to determine the causative disease and treat it. It is best for patients to keep a diary in which they record the nature and intensity of their symptoms. This makes it easier for the doctor to diagnose the underlying condition. If the erythema nodosum is caused by the contraceptive pill, the patient should change to a different preparation in consultation with the gynecologist. The three-month injection and the hormonal IUD are also possible triggers that must be discontinued if nodular erythema nodosum occurs. Surgery may be necessary for painful lumps in the subcutaneous fat tissue. The doctor will decide this after a comprehensive examination and tell the patient what preparatory measures to take. Basically, before and after surgery, take it easy and avoid stress. A balanced diet can promote recovery and also alleviate acute symptoms of erythema nodosum.
