Nodal erythema: symptoms and treatment

Nodular erythema is a systemic disease of connective tissue, in which the skin and subcutaneous fatty tissue are affected. It appears on the skin moderately dense knots, the sizes of which vary from 0.5-5 cm and more in diameter. With palpation, they are quite painful.

In 1/3 of the patients, nodal erythema begins to progress as an independent disease. In this case, it is a question of the progression of the primary form of pathology. But still more often it develops against the background of already existing pathology in the body.

Doctors call nodosum erythema one of the subforms of allergic vasculitis. As it develops, local vascular damage occurs. Most often this is noted on the lower limbs. Restrictions, regarding sex and age, do not have pathology. Men, women and even children are affected. But it is worth noting the fact that 6 sick women account for only one sick man. This gives grounds to assume that the erythema nodal nevertheless more often «attacks» the fair sex.


The main reasons for the progression of the human nodal erythema to date have not yet been accurately established. Scientists suggest that the hereditary factor plays a significant role in the development of this pathology. They also note that in some clinical situations, nodosum erythema is a nonspecific immune-inflammatory syndrome. To provoke the manifestation of pathology may be infectious and non-infectious causes.

Non-infectious causes:

  • sarcoidosis is a common cause contributing to the progression of nodal erythema
  • Behcet’s syndrome;
  • bowel diseases of an inflammatory nature
  • Pregnancy. In pregnant women, erythema nodosum often develops on the lower limbs;
  • leukemia
  • Acceptance of certain groups of synthetic medicines. These include hormonal contraception, antibiotics, iodides, salicylates and others
  • neoplasms of benign and malignant nature
  • vaccination.

Infectious factors:

  1. Histoplasmosis
  2. diseases that were caused by streptococcal infection
  3. iersiniosis
  4. hepatitis B
  5. syphilis
  6. cytomegalovirus
  7. Tuberculosis
  8. cat scratch disease
  9. psittacosis
  10. Chlamydia;
  11. trichophytosis and others.

The mechanism of development of erythema nodosum has not been fully studied by scientists. But there is a suggestion that chemicals or infectious agents create an antigenic background in the human body. A healthy organism will not feel any changes at all, but a genetically predisposed one immediately reacts — it will trigger a chain of biochemical reactions during which specific antibodies will be formed.


In medicine, there are three main forms of erythema nodosum. They are divided depending on the nature of the course, the severity of the symptoms, and the prescription of the pathology.

Acute erythema nodosum

The main symptom of acute erythema nodosum is the formation of pathological nodes on the lower limbs. As a rule, they are localized on the front surface of the shins, in the ankle and knee joints. More rarely formations are formed on forearms and feet. The arrangement of the nodules is symmetrical. Dimensions of the formations vary from 0.5 to 5 cm. When palpating, it can be noted that they are dense. With pressure, painful. Nodes can slightly rise above the surface of the skin. The boundaries of the formations are indistinct, as the surrounding tissues are edematous.

First, the skin above the nodes is smooth and has a reddish-pink hue. As the pathology develops, it becomes cyanotic, and in the final stage — greenish-yellow. With nodosum erythema, one small nodule is first formed on the legs, which begins to expand rapidly in size. When he reaches his maximum, he stops growing. Pain syndrome can be noted not only with physical effects on education. Sometimes it arises spontaneously. Pain can be either weak or severe.

After 3-6 weeks from the onset of progression of the pathology, the nodules gradually disappear. After that, there are no scars or other changes on the skin. Possible light pigmentation or peeling. Itching is not typical. Relapses do not occur.

Additional symptoms:

  • general weakness;
  • raising the temperature to 39 degrees;
  • headaches are possible;
  • pain in the joints and muscles of the volatile nature.

The migrating form

With this form of pathology, the symptoms are not pronounced clearly. At first the patient begins to feel weakness and malaise. Complains of pain in the joints and muscles. Body temperature rises to 38 degrees, chills occur. Then knotty erythema on the legs begins to manifest. A single node appears on the anterolateral surface of the tibia. It is dense and flat. From healthy tissues it is limited. Skin over formation has a bluish-red hue.

As the pathology develops, the infiltrate acquires the property of migrating, which causes the plaque to form. Outwardly it looks like a ring. In the center there is a pale indentation, and the peripheral zone is colored red. Later on the surface of the legs may form more nodules.

Chronic form

Chronic erythema nodosum affects mainly women aged 40 years, who have tumors of the pelvic organs, as well as chronic pathologies of infectious nature. Symptoms of intoxication of the body may be completely absent or be very poorly expressed. Pathological nodules are located in typical places — on the shins, buttocks, etc. But to notice them is difficult, because over the surface of the skin they do not rise and the color above them does not change the skin. The pathological process can become aggravated from time to time and then the symptoms become worse. Most often this happens in the autumn-spring period.

Erythema nodosum in children

Most often, the disease affects children at the age of six. It is worth noting that girls are sick more often than boys. The main reasons for the formation of pathological elements are infectious pathologies, allergic reaction and abnormalities in GIT.


  1. in children, the first symptoms appear 5 days after the onset of the disease;
  2. the child is whimsical and irritated
  3. children have pronounced symptoms of intoxication: weakness, fever, headache, abdominal pain and joint pain
  4. physical contact with affected areas causes severe pain;
  5. knots, hot to the touch, form on hips, shins or forearms. Their size does not exceed a walnut. Skin over formations blushes;
  6. Later the color of the formations changes to brown, and then to cyanotic and yellowish-green

If these symptoms are found in children, the pediatrician should be consulted immediately to conduct a thorough diagnosis and to identify the main cause of progression of the pathology. Children with this disease are treated only in a hospital setting.


Diagnostics includes laboratory and instrumental examination techniques:

  • blood test
  • blood test for rheumatic tests
  • Ultrasound of the lower limb veins
  • bassing from the nasopharynx;
  • tuberculin diagnostics
  • biopsy of nodules
  • chest X-ray;
  • CT;
  • Bacterial feces.


Treatment of erythema nodosum should be done only by a highly qualified specialist. If the doctor was able to determine which disease triggered the development of pathology, then in the first place, it is necessary to start treating it. If nodal erythema develops against the background of an infectious disease, then antiviral, antibacterial and antifungal drugs are prescribed.

In the primary form of pathology, these drugs are prescribed:

  1. antihistamines
  2. Non-steroidal anti-inflammatory drugs
  3. aminoquinoline preparations
  4. corticosteroids.

For local treatment, it is shown to use anti-inflammatory ointments (including hormones), to make compresses. Also, a good effect in the treatment of ailment is given by physiotherapy. Assign laser therapy, phonophoresis, magnetotherapy, ultraviolet radiation.

As an additional therapy, you can use folk remedies, but only after agreeing them with your doctor. Uncontrolled use can not only not help, but also aggravate the course of the disease.

Folk remedies for the treatment of erythema nodosum:

  • ointment with arnica
  • mountain arnica infusion
  • tincture with red elderberry

  • trays with manganese.