EpistemisErythema nodosum
Specialty: Skin.
Why it occurs
- Previous streptococcal infection (pharyngotonsillitis due to group A beta-hemolytic streptococcus)
- Sarcoidosis (associated with bilateral hilar lymphadenopathy in Löfgren's syndrome)
- Inflammatory bowel disease such as ulcerative colitis or Crohn's disease
- Hypersensitivity reaction to drugs (sulfonamides, oral contraceptives, penicillins)
- Active tuberculosis or systemic mycoses.
Initial workup
Complete blood count, erythrocyte sedimentation rate (ESR), C-reactive protein (CRP), antistreptolysin O titer (ASLO), chest x-ray to rule out hilar lymphadenopathy or parenchymal infiltrates, tuberculin test (PPD) or IGRA, and deep incisional biopsy that includes subcutaneous cellular tissue if the clinical diagnosis is inconclusive.
red flags
Persistent idiopathic high fever, compromised general condition with marked dyspnea or dry cough (suspected sarcoidosis or tuberculosis), chronic diarrhea with blood or mucus, or persistence of ulcerated nodules (suggesting changing the diagnosis to lobular panniculitis or nodular vasculitis).
Standard management
- Indomethacin — non-steroidal anti-inflammatory drug of choice for the management of pain and nodular inflammation, dose of 50 mg every 8 hours orally
- Potassium iodide — saturated solution administered orally to stabilize neutrophil degranulation in subacute cases
- Prednisone — systemic corticosteroid indicated only if an underlying active infectious process is ruled out
- Cold compresses applied locally along with absolute rest with elevation of the lower limbs.
Educational guidance for study. It is NOT a prescription recommendation. The actual choice depends on the cause, the patient, and current guidelines.
- Area
- Skin
- Listed causes
- 5
- Treatment options
- 4