Causes and risk factors
Erythema nodsosum is associated with several disease conditions. Infections by Streptococcus, coccidioidomycosis; infections like tuberculosis, hepatitis B, syphilis, cat scratch disease, tularemia, Yersinia, leptospirosis, psittacosis, histoplasmosis, mononucleosis [EBV] can cause the disease condition. Sensitivity to certain medications like oral contraceptives and certain antibiotics can also lead to this disease condition. Other associated disorders include leukemia, sarcoidosis, rheumatic fever, ulcerative colitis, Behcet’s disease, Crohn’s disease, non-Hodgkin’s lymphoma, carcinoid tumors, and pancreatic cancer. Normal pregnancy can also be one of the associated factors.
Clinical presentation
The disease occurs commonly on the shin, but can be seen on other parts also. Symptoms of erythema nodosum include red, tender nodules or lump on both shins. Nodules are of varying size ranging from 1-10 cm in diameter. Nodules change their colour over a period of time from bluish purple, brown, yellowish to green. In 2-6 weeks, nodules subside without ulceration or scarring. Accompanying symptoms include fever, malaise, joint aches, skin redness, inflammation, or irritation; swelling of the leg or other affected area.
Investigation
Medical history by the patient and clinical examination by the dermatologist helps in diagnosis. Biopsy of the nodule is done to confirm the diagnosis. Complete blood count with ESR, antistreptolysin O [ASO] titer, test for C-reactive protein are done. Throat culture is obtained. Tuberculin test is recommended. Imaging studies such chest x-ray may be useful for further evaluation.
Treatment
Treatment involves finding and treating the underlying cause. Nonsteroidal anti-inflammatory medications [NSAIDs] may be prescribed to reduce symptoms. Patient is asked to take bedrest with leg elevation. Compression stocking is recommended. Corticosteroids are used in some cases to reduce inflammation.
Other Modes of treatment
The other modes of treatment can also be effective in treating erythema nodosum. Homoeopathy is a science which deals with individualization and considers a person in a holistic way. This science can be helpful in combating the symptoms. Similarly, the Ayurvedic system of medicine which uses herbal medicines and synthetic derivates is also found to be effective in treating erythema nodosum.
