Materiały źródłowe

• #1 Erythema Nodosum: Symptoms, Causes & Treatment

  https://my.clevelandclinic.org/health/diseases/24565-erythema-nodosum

  Treatment varies for each person diagnosed with erythema nodosum and depends on what caused your symptoms. Treatment could include: […] Erythema nodosum can resolve on its own after a few weeks to months and doesn’t always need treatment. […] Treatment could involve taking medications to manage your symptoms, including: […] After treatment begins, you could see your symptoms of pain and swelling reduce. […] If you manage or treat the underlying condition that caused your symptoms or you stop taking medicine that caused your symptoms, you reduce your risk of having an erythema nodosum flare. […] At home, you can take over-the-counter NSAIDs for pain as directed by your healthcare provider. […] Elevating the affected area of your body helps minimize swelling. […] If your symptoms are severe and prevent you from going about your day normally, talk to your healthcare provider.

• #2 Erythema Nodosum – Skin Disorders – Merck Manual Consumer Version

  https://www.merckmanuals.com/home/skin-disorders/hypersensitivity-and-reactive-skin-disorders/erythema-nodosum

  Erythema nodosum usually is caused by a reaction to a medication, an infection (bacterial, fungal, or viral), or another disorder such as inflammatory bowel disease. […] People stop taking suspected medications, underlying conditions or infections are treated, and pain is relieved by bed rest, nonsteroidal anti-inflammatory drugs, and sometimes a corticosteroid. […] Leg elevation and cool compresses […] Nonsteroidal anti-inflammatory drugs (NSAIDs) for pain […] Treatment of underlying disorders […] Erythema nodosum almost always resolves on its own, and the nodules usually go away in 3 to 6 weeks without treatment. Bed rest, cool compresses, elevation of the legs, and NSAIDs may help relieve the pain caused by the nodules. Potassium iodide tablets may be given to decrease inflammation.

• #3 Erythema Nodosum Treatment & Management: Medical Care, Activity, Prevention

  https://emedicine.medscape.com/article/1081633-treatment

  In most patients, erythema nodosum (EN) is a self-limited disease that requires only symptomatic relief in the form of analgesics, cool wet compresses, elevation, and bed rest. If an underlying disease or drug is identified as the cause of EN, it should be eliminated. […] Given that EN often regresses spontaneously, relief of symptoms through administration of nonsteroidal anti-inflammatory drugs (NSAIDs; eg, acetylsalicylic acid, ibuprofen, naproxen, and indomethacin) may be the only treatment necessary. Corticosteroids are effective but are seldom necessary in self-limited disease. Potassium iodide has been used with the aim of alleviating lesional tenderness, arthralgia, and fever. However, a study that included nine patients with EN found that only five of the nine derived benefit from potassium iodide and that the remaining four derived no benefit at all.

• #4 Erythema nodosum – symptoms, causes, diagnosis and treatment | healthdirect

  https://www.healthdirect.gov.au/erythema-nodosum

  Erythema nodosum causes painful red lumps, usually on your lower legs. […] Resting with your legs up, wearing support stockings and taking anti-inflammatory medicines can help ease your symptoms. […] If your doctor can’t find a cause of your erythema nodosum, you will be advised to wear compression stockings and rest with your legs elevated. […] You can take anti-inflammatory medicines to help with any pain. […] Your doctor may recommend you take oral corticosteroids or use a steroid injection. In some cases, potassium iodide or colchicine tablets are prescribed.

• #5 Erythema nodosum: Symptoms, Causes, and Management — DermNet

  https://dermnetnz.org/topics/erythema-nodosum

  Erythema nodosum is treated based on the underlying disease. An underlying infection should be treated. […] Pain management may include extended rest, colchicine (12 mg/day), NSAIDs (non-steroidal anti-inflammatory drugs), and venous compression therapy. […] Systemic corticosteroids (1 mg/kg daily until resolution of erythema nodosum) may be prescribed if infection, sepsis, and malignancy have been ruled out. […] Oral potassium iodide as a supersaturated solution (400-900 mg/day) may be prescribed for one month if available.

• #6 Erythema nodosum – UpToDate

  https://www.uptodate.com/contents/erythema-nodosum

  Erythema nodosum (EN) is a delayed-type hypersensitivity reaction that most often presents as erythematous, tender nodules on the shins. […] When necessary, treatment can be given to reduce symptoms or hasten resolution. […] First-line therapy includes nonsteroidal anti-inflammatory drugs and potassium iodide. […] Second-line therapy includes systemic glucocorticoids and intralesional corticosteroid injections. […] For recalcitrant, chronic, or recurring disease, dapsone, colchicine, and hydroxychloroquine may be used.

• #7 Erythema Nodosum: Symptoms, Causes, Diagnosis, and Treatment

  https://www.webmd.com/skin-problems-and-treatments/erythema-nodosum

  The treatment usually depends on what’s causing it. For instance, if it’s caused by an erythema nodosum-associated condition or infection, your doctor will treat that. If it’s caused by a medication, your doctor will likely have you stop taking that medicine or switch you to a different one. But don’t stop taking any medicine unless your doctor tells you to do so. […] You can help manage your symptoms with some at-home therapies, such as: […] Use compression stockings or bandages to help with the swelling and pain. […] Rest and avoid hard activities. […] Lift the affected part of your body. For instance, put your legs on a pillow while you’re lying down. […] Use NSAIDs to help with the swelling and pain. […] Medicines that may control your swelling and pain include: […] NSAIDs, like ibuprofen or naproxen. Be careful with these if you have inflammatory bowel disease (IBD) because they can make your IBD symptoms worse. Ask your doctor about what to take instead.

• #8 Erythema nodosum

  https://www.nhs.uk/conditions/erythema-nodosum/

  There are some things you can do to help ease the pain of erythema nodosum. […] Treatment for erythema nodosum depends on the cause. […] If it’s caused by another condition, treating that condition may help. For example, if its caused by an infection, you may be given antibiotics. […] If your symptoms have lasted a long time or they keep returning, other treatments, such as steroid tablets, may be recommended.

• #9 Erythema Nodosum: Symptoms, Causes, Diagnosis, and Treatment

  https://www.webmd.com/skin-problems-and-treatments/erythema-nodosum

  The treatment usually depends on what’s causing it. For instance, if it’s caused by an erythema nodosum-associated condition or infection, your doctor will treat that. If it’s caused by a medication, your doctor will likely have you stop taking that medicine or switch you to a different one. But don’t stop taking any medicine unless your doctor tells you to do so. […] You can help manage your symptoms with some at-home therapies, such as: […] Use compression stockings or bandages to help with the swelling and pain. […] Rest and avoid hard activities. […] Lift the affected part of your body. For instance, put your legs on a pillow while you’re lying down. […] Use NSAIDs to help with the swelling and pain. […] Medicines that may control your swelling and pain include: […] NSAIDs, like ibuprofen or naproxen. Be careful with these if you have inflammatory bowel disease (IBD) because they can make your IBD symptoms worse. Ask your doctor about what to take instead.

• #10 Erythema Nodosum – Skin Disorders – Merck Manual Consumer Version

  https://www.merckmanuals.com/home/skin-disorders/hypersensitivity-and-reactive-skin-disorders/erythema-nodosum

  Corticosteroids taken by mouth are effective but are given only as a last resort because they can worsen an underlying infection even if one has not been identified. […] Medications that might be causing erythema nodosum are stopped, and any underlying infections or disorders are treated. If the disorder is caused by a streptococcal infection, a person may have to take antibiotics, such as penicillin, or a cephalosporin.

• #11 Erythema Nodosum Treatment & Management: Medical Care, Activity, Prevention

  https://emedicine.medscape.com/article/1081633-treatment

  In most patients, erythema nodosum (EN) is a self-limited disease that requires only symptomatic relief in the form of analgesics, cool wet compresses, elevation, and bed rest. If an underlying disease or drug is identified as the cause of EN, it should be eliminated. […] Given that EN often regresses spontaneously, relief of symptoms through administration of nonsteroidal anti-inflammatory drugs (NSAIDs; eg, acetylsalicylic acid, ibuprofen, naproxen, and indomethacin) may be the only treatment necessary. Corticosteroids are effective but are seldom necessary in self-limited disease. Potassium iodide has been used with the aim of alleviating lesional tenderness, arthralgia, and fever. However, a study that included nine patients with EN found that only five of the nine derived benefit from potassium iodide and that the remaining four derived no benefit at all.

• #12 Erythema Nodosum: A Sign of Systemic Disease | AAFP

  https://www.aafp.org/pubs/afp/issues/2007/0301/p695.html

  Erythema nodosum tends to be self-limited. The most common approach is treatment of any underlying disorders and supportive therapy, including bed rest and avoidance of contact irritation of affected areas. Pain can be managed conservatively with nonsteroidal anti-inflammatory drugs (NSAIDs). More aggressive pain management is reserved for clinical situations that become recurrent or unusually prolonged. […] Oral potassium iodide prepared as a supersaturated solution in a dosage of 400 to 900 mg per day for one month is a therapeutic option. Potassium iodide therapy is more likely to be effective in providing symptomatic relief if begun at the onset of the erythema nodosum. […] Systemic steroids have been advocated as a relatively safe therapeutic option if underlying infection, risk of bacterial dissemination or sepsis, and malignancy have been excluded by a thorough evaluation. Oral prednisone at a dosage of 60 mg every morning is typical. A general rule is 1 mg per kg body weight per day.

• #13 Erythema nodosum: Causes, symptoms, and pictures

  https://www.medicalnewstoday.com/articles/320829

  Erythema nodosum (EN) symptoms can include painful bumps under the skin on the legs, fever, fatigue, and joint swelling. Treatment may include rest, ice, and anti-inflammatory medications. […] With proper rest, most cases of EN resolve on their own within 1 to 2 months, with new sores continuing to develop or spread throughout the first few weeks. […] The treatment recommended for each case of EN depends on the cause. Underlying infections or medical conditions will also require treatment. […] Common forms of treatment for EN include: bed rest, especially if swelling and pain is severe; changing any medications that cause EN, but only at a doctors discretion; applying ice wrapped in a towel to the affected area for 15 to 20 minutes at a time, several times daily; elevating the affected area using a prop, such as a pillow; over-the-counter pain and anti-inflammatory medications; light compression stockings or supportive bandages and wraps; oral tetracycline; potassium iodide, often 400 to 900 micrograms (mcg) per day for 1 month when symptoms begin; systemic corticosteroids, often prednisone; steroid creams.

• #14 Erythema Nodosum: Causes, Symptoms, and Treatment

  https://patient.info/skin-conditions/erythema-nodosum

  The rounded lumps (nodules) of erythema nodosum tend to go away by themselves and often do not need any treatment. However, they may be very tender or painful and certain treatments may be suggested to help relieve these symptoms. […] Treatments may include: Painkiller medication. Non-steroidal anti-inflammatory drugs (NSAIDs) – for example, ibuprofen – are commonly used to help relieve pain. Sometimes stronger painkillers are needed. […] Bed rest and keeping your legs raised above the level of your heart may help with pain relief. […] Wearing firm, supportive bandages or stockings on your legs is another option. You can ask your doctor to advise about this. […] Cool wet compresses over the nodules may also help to relieve pain. […] Potassium iodide. In some people with erythema nodosum, this liquid taken by mouth may help relieve the pain in the nodules and also the joint pains. It is not certain exactly how this works and it is not effective in everyone.

• #15 Erythema nodosum – Dermatology Advisor

  https://www.dermatologyadvisor.com/home/decision-support-in-medicine/dermatology/erythema-nodosum-3/

  All patients should incorporate bed rest and leg elevation (above the level of the heart) as part of the treatment approach. Compressive therapy is advised whenever possible (gradient support stockings, ACE-compression wraps, or Coban self-adherent wraps), to a 15 to 20mm Hg pressure (unless contraindicated due to severe arterial insufficiency or circulatory compromise). […] NSAIDs are effective at treating the skin lesions and often the systemic symptoms of EN in many patients. Indomethacin and naproxen have the most evidence and experience supporting their use. These are generally well tolerated, although patients with renal disease, gastritis, or esophagitis may develop drug-related complications. Starting with indomethacin 50mg 3 times daily along with compression, elevation, and rest is an effective initial treatment and will lead to good results in the majority of patients with idiopathic EN. NSAIDs should not be used late in pregnancy.

• #16 Erythema Nodosum: A Practical Approach and Diagnostic Algorithm

  https://pmc.ncbi.nlm.nih.gov/articles/PMC7938036/

  Erythema nodosum is the most common form of panniculitis and is characterized by tender erythematous nodules mainly in the lower limbs on the pretibial area. […] Several treatment options for the erythema nodosum lesions have been previously reported; nevertheless, these options treat the symptoms, but not the triggering cause. Making an accurate diagnosis will allow the physician to treat the underlying cause and determine an optimal therapeutic strategy. […] Therapy options are summarized in Table 4. Symptomatic support is an adequate approach for most patients. Compression bandages and limb elevation may be used for edema and pain relief. Non-steroidal anti-inflammatory drugs, such as indomethacin at 100-150 mg/day or naproxen 500 mg/day, may be used for pain control. […] In refractory disease, oral potassium iodide may be used with a dose of 300-900 mg daily divided into three doses and tapered to 150 mg/day.

• #17 Erythema nodosum – Dermatology Advisor

  https://www.dermatologyadvisor.com/home/decision-support-in-medicine/dermatology/erythema-nodosum-3/

  All patients should incorporate bed rest and leg elevation (above the level of the heart) as part of the treatment approach. Compressive therapy is advised whenever possible (gradient support stockings, ACE-compression wraps, or Coban self-adherent wraps), to a 15 to 20mm Hg pressure (unless contraindicated due to severe arterial insufficiency or circulatory compromise). […] NSAIDs are effective at treating the skin lesions and often the systemic symptoms of EN in many patients. Indomethacin and naproxen have the most evidence and experience supporting their use. These are generally well tolerated, although patients with renal disease, gastritis, or esophagitis may develop drug-related complications. Starting with indomethacin 50mg 3 times daily along with compression, elevation, and rest is an effective initial treatment and will lead to good results in the majority of patients with idiopathic EN. NSAIDs should not be used late in pregnancy.

• #18 Erythema Nodosum Treatment & Management: Medical Care, Activity, Prevention

  https://emedicine.medscape.com/article/1081633-treatment

  In most patients, erythema nodosum (EN) is a self-limited disease that requires only symptomatic relief in the form of analgesics, cool wet compresses, elevation, and bed rest. If an underlying disease or drug is identified as the cause of EN, it should be eliminated. […] Given that EN often regresses spontaneously, relief of symptoms through administration of nonsteroidal anti-inflammatory drugs (NSAIDs; eg, acetylsalicylic acid, ibuprofen, naproxen, and indomethacin) may be the only treatment necessary. Corticosteroids are effective but are seldom necessary in self-limited disease. Potassium iodide has been used with the aim of alleviating lesional tenderness, arthralgia, and fever. However, a study that included nine patients with EN found that only five of the nine derived benefit from potassium iodide and that the remaining four derived no benefit at all.

• #19 Erythema Nodosum – Skin Disorders – Merck Manual Consumer Version

  https://www.merckmanuals.com/home/skin-disorders/hypersensitivity-and-reactive-skin-disorders/erythema-nodosum

  Erythema nodosum usually is caused by a reaction to a medication, an infection (bacterial, fungal, or viral), or another disorder such as inflammatory bowel disease. […] People stop taking suspected medications, underlying conditions or infections are treated, and pain is relieved by bed rest, nonsteroidal anti-inflammatory drugs, and sometimes a corticosteroid. […] Leg elevation and cool compresses […] Nonsteroidal anti-inflammatory drugs (NSAIDs) for pain […] Treatment of underlying disorders […] Erythema nodosum almost always resolves on its own, and the nodules usually go away in 3 to 6 weeks without treatment. Bed rest, cool compresses, elevation of the legs, and NSAIDs may help relieve the pain caused by the nodules. Potassium iodide tablets may be given to decrease inflammation.

• #20 7 Tips for Dealing with Erythema Nodosum If You Have IBD

  https://www.bezzyibd.com/discover/managing-ibd/health-7-tips-for-dealing-with-erythema-nodosum-if-you-have-ibd/

  Erythema nodosum is one of the common complications of IBD. […] One of the recommended treatments for erythema nodosum is taking nonsteroidal anti-inflammatory drugs (NSAIDs). However, people with IBD are told to avoid NSAIDs as they may make intestinal symptoms worse. […] The good news is that often the meds you’re already taking for IBD may actually help relieve erythema nodosum symptoms. Both steroids and the biologic drug infliximab have been shown to be effective treatments of erythema nodosum. […] Compression therapy is often recommended for managing erythema nodosum symptoms. Your doctor might prescribe support stockings or compression wraps. […] For people who can’t take NSAIDs, ice therapy can be a good alternative for symptom relief. […] One of the best things you can do if you have erythema nodosum is giving your body plenty of time to rest and recover. […] It’s important to remember that while erythema nodosum can be painful and frustrating, most symptoms resolve within 2 to 4 weeks. If an IBD flare-up has triggered your erythema nodosum, the nodules and pain will likely subside when your IBD is in remission.

• #21 Erythema Nodosum: A Sign of Systemic Disease | AAFP

  https://www.aafp.org/pubs/afp/issues/2007/0301/p695.html

  Treatment also may be tailored to disease-specific regimens: steroids used in combination with hydroxychloroquine (Plaquenil), cyclosporin A (Sandimmune), or thalidomide (Thalomid) have been used to treat inflammatory bowel disease-associated erythema nodosum. NSAIDs should be avoided in treating erythema nodosum secondary to Crohn’s disease because they may trigger a flare-up or worsen an ongoing acute bout. Colchicine has been used in patients with erythema nodosum and coexisting Behet’s syndrome, with varying results.

• #22 Erythema Nodosum: A Sign of Systemic Disease | AAFP

  https://www.aafp.org/pubs/afp/issues/2007/0301/p695.html

  Erythema nodosum tends to be self-limited. The most common approach is treatment of any underlying disorders and supportive therapy, including bed rest and avoidance of contact irritation of affected areas. Pain can be managed conservatively with nonsteroidal anti-inflammatory drugs (NSAIDs). More aggressive pain management is reserved for clinical situations that become recurrent or unusually prolonged. […] Oral potassium iodide prepared as a supersaturated solution in a dosage of 400 to 900 mg per day for one month is a therapeutic option. Potassium iodide therapy is more likely to be effective in providing symptomatic relief if begun at the onset of the erythema nodosum. […] Systemic steroids have been advocated as a relatively safe therapeutic option if underlying infection, risk of bacterial dissemination or sepsis, and malignancy have been excluded by a thorough evaluation. Oral prednisone at a dosage of 60 mg every morning is typical. A general rule is 1 mg per kg body weight per day.

• #23 Erythema nodosum – Dermatology Advisor

  https://www.dermatologyadvisor.com/home/decision-support-in-medicine/dermatology/erythema-nodosum-3/

  Potassium iodide is an effective, generally well-tolerated, non-immunosuppressive treatment that can achieve rapid disease control. It is generally administered as a saturated solution (SSKI); patients should start with 1 to 2 drops (often dissolved in orange juice to increase patient tolerability) taken 3 times daily. The dose can be increased by 1 drop per dose weekly up to 5 drops 3 times daily. […] In patients who fail to respond to rest, elevation, compression, and/or NSAIDs or SSKI, alternative therapies may be considered. Individual recalcitrant or refractory lesions may respond quickly to intralesional steroid injections. […] Prednisone is a very effective drug at controlling EN, and in severe, widespread, or very symptomatic patients it may be appropriate to consider initial treatment with prednisone to achieve more rapid disease control.

• #24 Erythema Nodosum: A Practical Approach and Diagnostic Algorithm

  https://pmc.ncbi.nlm.nih.gov/articles/PMC7938036/

  Erythema nodosum is the most common form of panniculitis and is characterized by tender erythematous nodules mainly in the lower limbs on the pretibial area. […] Several treatment options for the erythema nodosum lesions have been previously reported; nevertheless, these options treat the symptoms, but not the triggering cause. Making an accurate diagnosis will allow the physician to treat the underlying cause and determine an optimal therapeutic strategy. […] Therapy options are summarized in Table 4. Symptomatic support is an adequate approach for most patients. Compression bandages and limb elevation may be used for edema and pain relief. Non-steroidal anti-inflammatory drugs, such as indomethacin at 100-150 mg/day or naproxen 500 mg/day, may be used for pain control. […] In refractory disease, oral potassium iodide may be used with a dose of 300-900 mg daily divided into three doses and tapered to 150 mg/day.

• #25 Erythema Nodosum – Skin Disorders – Merck Manual Consumer Version

  https://www.merckmanuals.com/home/skin-disorders/hypersensitivity-and-reactive-skin-disorders/erythema-nodosum

  Erythema nodosum usually is caused by a reaction to a medication, an infection (bacterial, fungal, or viral), or another disorder such as inflammatory bowel disease. […] People stop taking suspected medications, underlying conditions or infections are treated, and pain is relieved by bed rest, nonsteroidal anti-inflammatory drugs, and sometimes a corticosteroid. […] Leg elevation and cool compresses […] Nonsteroidal anti-inflammatory drugs (NSAIDs) for pain […] Treatment of underlying disorders […] Erythema nodosum almost always resolves on its own, and the nodules usually go away in 3 to 6 weeks without treatment. Bed rest, cool compresses, elevation of the legs, and NSAIDs may help relieve the pain caused by the nodules. Potassium iodide tablets may be given to decrease inflammation.

• #26 Erythema Nodosum: Symptoms, Causes, Diagnosis, and Treatment

  https://www.webmd.com/skin-problems-and-treatments/erythema-nodosum

  Steroids, like prednisone. Your doctor may want to make sure you don’t have a bacterial infection before they prescribe these because they can make an underlying infection worse. […] Hydroxychloroquine, cyclosporin A, or thalidomide, especially if you have IBD as an underlying condition. […] Potassium iodide or tetracycline, especially if you have symptoms that are hard to manage. Your doctor may want to make sure you don’t have a thyroid disease before they prescribe potassium iodide because it can make thyroid disease worse. […] Colchicine, especially if you have Behcet’s disease as an underlying condition.

• #27 Erythema nodosum

  https://escholarship.org/uc/item/4829t6rn

  Treatment of erythema nodosum should be directed to the underlying associated condition, if identified. Usually, nodules of erythema nodosum regress spontaneously within a few weeks, and bed rest is often sufficient treatment. Aspirin and nonsteroidal anti-inflammatory drugs such as oxyphenbutazone, in a dosage of 400 mg per day, indomethacin, in a dosage of 100 to 150 mg per day, or naproxen, in a dosage of 500 mg per day, may be helpful to enhance analgesia and resolution. If the lesions persist longer, potassium iodide in a dosage of 400 to 900 mg daily or a saturated solution of potassium iodide, 2 to 10 drops in water or orange juice three times per day, has been reported to be useful. The mechanism of action of potassium iodide in erythema nodosum is unknown, but a theoretical mechanism involves its stimulation of heparin release from mast cells. Heparin acts to suppress delayed hypersensitivity reactions. The reported response in some patients with erythema nodosum lesions to heparinoid ointment under occlusion supports this proposed mechanism of action. On the other hand, potassium iodide also inhibits neutrophil chemotaxis. Potassium iodide is contraindicated during pregnancy, because it can produce a goiter in the fetus. Severe hypothyroidism secondary to exogenous intake of iodide has been also described in patients with erythema nodosum treated with potassium iodide.

• #28 Erythema Nodosum: A Practical Approach and Diagnostic Algorithm

  https://pmc.ncbi.nlm.nih.gov/articles/PMC7938036/

  Systemic and intralesional corticosteroids are rarely used to treat EN. Prednisone 40 mg/day has been used in severe conditions. For recalcitrant nodules, intralesional triamcinolone acetonide 5 mg/mL, injected to the center of an inflamed lesion, has been used. […] Some patients respond to hydroxychloroquine 200 mg twice daily. Tetracyclines, such as minocycline 100 mg twice daily and tetracycline 500 mg every 6-12 h, have been considered as an option for chronic EN. Tumor necrosis factor- inhibitors such as etanercept, adalimumab, and infliximab have been used in patients with recalcitrant disease. Thalidomide and cyclosporine A have been used in EN associated with IBD.

• #29 Erythema Nodosum: A Sign of Systemic Disease | AAFP

  https://www.aafp.org/pubs/afp/issues/2007/0301/p695.html

  Erythema nodosum tends to be self-limited. The most common approach is treatment of any underlying disorders and supportive therapy, including bed rest and avoidance of contact irritation of affected areas. Pain can be managed conservatively with nonsteroidal anti-inflammatory drugs (NSAIDs). More aggressive pain management is reserved for clinical situations that become recurrent or unusually prolonged. […] Oral potassium iodide prepared as a supersaturated solution in a dosage of 400 to 900 mg per day for one month is a therapeutic option. Potassium iodide therapy is more likely to be effective in providing symptomatic relief if begun at the onset of the erythema nodosum. […] Systemic steroids have been advocated as a relatively safe therapeutic option if underlying infection, risk of bacterial dissemination or sepsis, and malignancy have been excluded by a thorough evaluation. Oral prednisone at a dosage of 60 mg every morning is typical. A general rule is 1 mg per kg body weight per day.

• #30 Erythema Nodosum: A Practical Approach and Diagnostic Algorithm

  https://pmc.ncbi.nlm.nih.gov/articles/PMC7938036/

  Systemic and intralesional corticosteroids are rarely used to treat EN. Prednisone 40 mg/day has been used in severe conditions. For recalcitrant nodules, intralesional triamcinolone acetonide 5 mg/mL, injected to the center of an inflamed lesion, has been used. […] Some patients respond to hydroxychloroquine 200 mg twice daily. Tetracyclines, such as minocycline 100 mg twice daily and tetracycline 500 mg every 6-12 h, have been considered as an option for chronic EN. Tumor necrosis factor- inhibitors such as etanercept, adalimumab, and infliximab have been used in patients with recalcitrant disease. Thalidomide and cyclosporine A have been used in EN associated with IBD.

• #31 Erythema nodosum – Cancer Therapy Advisor

  https://www.cancertherapyadvisor.com/home/decision-support-in-medicine/hospital-medicine/erythema-nodosum/

  Management is directed at identification and treatment of the underlying cause if one can be identified. The condition is generally self-limited in idiopathic cases. […] Pain, inflammation, or arthralgias can be treated with strict bed rest, elevation of legs, and restriction of physical activity until resolution of lesions (a few weeks). These efforts can help prevent exacerbations. Salicylates and nonsteroidal antiinflammatory drugs (NSAIDS) such as ibuprofen or naproxen can also be used to alleviate symptoms. […] If needed, small volumes (0.1 mL) of intralesional corticosteroids (intralesional triamcinolone acetonide in a dosage of 5 mg/mL) can be injected into the center of the nodule and frequently leads to rapid involution of individual lesions. If lesions become persistent or recurrent, oral corticosteroids may be beneficial. A dose of 0.5 mg/kg of prednisone per day for a period of 1-2 months had variable success in one pediatric case series.

• #32 Erythema Nodosum-like Septal Panniculitis Secondary to Lenalidomide Therapy in a Patient With Janus Kinase 2-Positive Myelofibrosis – JDDonline – Journal of Drugs in Dermatology

  https://jddonline.com/articles/erythema-nodosum-like-septal-panniculitis-secondary-to-lenalidomide-therapy-in-a-patient-with-janus-S1545961616P1024X

  Erythema nodosum (EN) is a panniculitis frequently encountered secondary to medical therapy. […] The subcutaneous nodules improved with intralesional triamcinolone and topical clobetasol without discontinuation of lenalidomide. […] For dermatologic treatment of septal panniculitis, individual nodules were injected with triamcinolone (10 mg/ml, 0.25 cc/lesion, total 2.8 cc) and the patient applied nightly clobetasol 0.05% ointment under occlusion to involved skin with near resolution of pain and induration of affected lesions. […] Given improvement in cutaneous symptoms, there was no interruption or reduction in lenalidomide therapy.

• #33 Erythema Nodosum: A Practical Approach and Diagnostic Algorithm

  https://pmc.ncbi.nlm.nih.gov/articles/PMC7938036/

  Systemic and intralesional corticosteroids are rarely used to treat EN. Prednisone 40 mg/day has been used in severe conditions. For recalcitrant nodules, intralesional triamcinolone acetonide 5 mg/mL, injected to the center of an inflamed lesion, has been used. […] Some patients respond to hydroxychloroquine 200 mg twice daily. Tetracyclines, such as minocycline 100 mg twice daily and tetracycline 500 mg every 6-12 h, have been considered as an option for chronic EN. Tumor necrosis factor- inhibitors such as etanercept, adalimumab, and infliximab have been used in patients with recalcitrant disease. Thalidomide and cyclosporine A have been used in EN associated with IBD.

• #34 Erythema nodosum: presentation and treatment | Medicine Today

  https://medicinetoday.com.au/mt/2024/december/regular-series/erythema-nodosum-presentation-and-treatment

  Referral to a dermatologist for further investigation and management should be arranged for patients with EN that is chronic or recurrent or have lesions that do not respond to first-line therapy. For those with chronic EN or recalcitrant episodes, dapsone, potassium iodide, colchicine and hydroxychloroquine have shown benefit. […] Patients who develop EN during pregnancy should be referred to a dermatologist and consultation with a maternal-fetal medicine specialist considered before starting any medications.

• #35 Erythema Nodosum Treatment & Management: Medical Care, Activity, Prevention

  https://emedicine.medscape.com/article/1081633-treatment

  Colchicine has been used in a few refractory cases with good results. […] Recurrence of EN following discontinuance of treatment is common, and underlying infectious disease may be worsened. […] Compression stockings may be beneficial for reducing swelling and allowing patients to maintain their normal activity level. […] Restriction of physical activities while EN is active may prevent exacerbations of the disease. […] Consultations with a dermatologist, an internist, or both may be necessary for evaluation of the underlying cause of EN. […] The course of EN is benign and self-limited. Bed rest and restriction of physical activities are encouraged during the active phase.

• #36 Erythema Nodosum: Symptoms, Causes, Diagnosis, and Treatment

  https://www.webmd.com/skin-problems-and-treatments/erythema-nodosum

  Steroids, like prednisone. Your doctor may want to make sure you don’t have a bacterial infection before they prescribe these because they can make an underlying infection worse. […] Hydroxychloroquine, cyclosporin A, or thalidomide, especially if you have IBD as an underlying condition. […] Potassium iodide or tetracycline, especially if you have symptoms that are hard to manage. Your doctor may want to make sure you don’t have a thyroid disease before they prescribe potassium iodide because it can make thyroid disease worse. […] Colchicine, especially if you have Behcet’s disease as an underlying condition.

• #37 Erythema Nodosum: A Sign of Systemic Disease | AAFP

  https://www.aafp.org/pubs/afp/issues/2007/0301/p695.html

  Treatment also may be tailored to disease-specific regimens: steroids used in combination with hydroxychloroquine (Plaquenil), cyclosporin A (Sandimmune), or thalidomide (Thalomid) have been used to treat inflammatory bowel disease-associated erythema nodosum. NSAIDs should be avoided in treating erythema nodosum secondary to Crohn’s disease because they may trigger a flare-up or worsen an ongoing acute bout. Colchicine has been used in patients with erythema nodosum and coexisting Behet’s syndrome, with varying results.

• #38

  https://link.springer.com/article/10.1007/s40257-021-00592-w

  Treatment of erythema nodosum with colchicine. […] Dapsone for treatment of erythema nodosum. […] Hydroxychloroquine in the treatment of chronic erythema nodosum. […] Adverse events during oral colchicine use: a systematic review and meta-analysis of randomised controlled trials. […] Etanercept treatment of erythema nodosum. […] Refractory chronic erythema nodosum treated with adalimumab. […] Treatment of chronic erythema nodosum with infliximab.

• #39 Erythema Nodosum: A Practical Approach and Diagnostic Algorithm

  https://pmc.ncbi.nlm.nih.gov/articles/PMC7938036/

  Systemic and intralesional corticosteroids are rarely used to treat EN. Prednisone 40 mg/day has been used in severe conditions. For recalcitrant nodules, intralesional triamcinolone acetonide 5 mg/mL, injected to the center of an inflamed lesion, has been used. […] Some patients respond to hydroxychloroquine 200 mg twice daily. Tetracyclines, such as minocycline 100 mg twice daily and tetracycline 500 mg every 6-12 h, have been considered as an option for chronic EN. Tumor necrosis factor- inhibitors such as etanercept, adalimumab, and infliximab have been used in patients with recalcitrant disease. Thalidomide and cyclosporine A have been used in EN associated with IBD.

• #40

  https://link.springer.com/article/10.1007/s40257-021-00592-w

  Treatment of erythema nodosum with colchicine. […] Dapsone for treatment of erythema nodosum. […] Hydroxychloroquine in the treatment of chronic erythema nodosum. […] Adverse events during oral colchicine use: a systematic review and meta-analysis of randomised controlled trials. […] Etanercept treatment of erythema nodosum. […] Refractory chronic erythema nodosum treated with adalimumab. […] Treatment of chronic erythema nodosum with infliximab.

• #41 Erythema nodosum – Dermatology Advisor

  https://www.dermatologyadvisor.com/home/decision-support-in-medicine/dermatology/erythema-nodosum-3/

  Certain cases of chronic EN respond well to hydroxychloroquine therapy; this drug may be particularly appropriate in rare cases of lupus-associated EN. Dapsone is very effective at treating certain cases of neutrophilic-mediated inflammation and neutrophilic vasculitides, and some patients with EN resistant to other treatment approaches will respond to dapsone therapy. […] Some patients with severe, refractory, recalcitrant disease may require alternative immunosuppressive and immunomodulatory agents. TNF alpha likely plays a role in sarcoidosis-associated EN and may be an important cytokine in EN in general. Thalidomide and the newer biologic TNF alpha-inhibitors have been used with success in treating limited numbers of patients with EN. Mycophenolate mofetil, cyclosporine, erythromycin, and extracorporeal monocyte granulocytapheresis have been reported to induce remission of EN in limited numbers of patients.

• #42 Erythema nodosum

  https://escholarship.org/uc/item/4829t6rn

  Systemic corticosteroids are rarely indicated in erythema nodosum and before these drugs are administered an underlying infection should be ruled out. When administered, prednisone in a dosage of 40 mg per day has been followed by resolution of the nodules in few days. Intralesional injection of triancinolone acetonide, in a dosage of 5 mg/ml, into the center of the nodules may cause them to resolve. […] Some patients may respond to a course of colchicine, 0.6 to 1.2 mg twice daily. Hydroxychloroquine, 200 mg twice a day, has also been reported to be useful in a recent report.

• #43 Erythema nodosum | Better Health Channel

  https://www.betterhealth.vic.gov.au/health/conditionsandtreatments/erythema-nodosum

  Treatments include medications, bed rest and treatment for any underlying condition. […] Treatment depends on the underlying cause, but may include: bed rest to relieve pressure and reduce swelling, support stockings or bandages, the use of alternating hot and cold compresses to ease pain, non-steroidal anti-inflammatory medications (NSAIDs), corticosteroids to reduce inflammation, treatment of the underlying cause for example, treating the infection or changing the treatment if medications are the cause, other medications have been reported to be useful, including dapsone, colchicine, hydroxychloroquine and erythromycin.

• #44

  https://link.springer.com/article/10.1007/s40257-021-00592-w

  Treatment of erythema nodosum with colchicine. […] Dapsone for treatment of erythema nodosum. […] Hydroxychloroquine in the treatment of chronic erythema nodosum. […] Adverse events during oral colchicine use: a systematic review and meta-analysis of randomised controlled trials. […] Etanercept treatment of erythema nodosum. […] Refractory chronic erythema nodosum treated with adalimumab. […] Treatment of chronic erythema nodosum with infliximab.

• #45 Erythema nodosum – Dermatology Advisor

  https://www.dermatologyadvisor.com/home/decision-support-in-medicine/dermatology/erythema-nodosum-3/

  Certain cases of chronic EN respond well to hydroxychloroquine therapy; this drug may be particularly appropriate in rare cases of lupus-associated EN. Dapsone is very effective at treating certain cases of neutrophilic-mediated inflammation and neutrophilic vasculitides, and some patients with EN resistant to other treatment approaches will respond to dapsone therapy. […] Some patients with severe, refractory, recalcitrant disease may require alternative immunosuppressive and immunomodulatory agents. TNF alpha likely plays a role in sarcoidosis-associated EN and may be an important cytokine in EN in general. Thalidomide and the newer biologic TNF alpha-inhibitors have been used with success in treating limited numbers of patients with EN. Mycophenolate mofetil, cyclosporine, erythromycin, and extracorporeal monocyte granulocytapheresis have been reported to induce remission of EN in limited numbers of patients.

• #46 Erythema nodosum: presentation and treatment | Medicine Today

  https://medicinetoday.com.au/mt/2024/december/regular-series/erythema-nodosum-presentation-and-treatment

  Referral to a dermatologist for further investigation and management should be arranged for patients with EN that is chronic or recurrent or have lesions that do not respond to first-line therapy. For those with chronic EN or recalcitrant episodes, dapsone, potassium iodide, colchicine and hydroxychloroquine have shown benefit. […] Patients who develop EN during pregnancy should be referred to a dermatologist and consultation with a maternal-fetal medicine specialist considered before starting any medications.

• #47 Erythema Nodosum: A Practical Approach and Diagnostic Algorithm

  https://pmc.ncbi.nlm.nih.gov/articles/PMC7938036/

  Erythema nodosum is the most common form of panniculitis and is characterized by tender erythematous nodules mainly in the lower limbs on the pretibial area. […] Several treatment options for the erythema nodosum lesions have been previously reported; nevertheless, these options treat the symptoms, but not the triggering cause. Making an accurate diagnosis will allow the physician to treat the underlying cause and determine an optimal therapeutic strategy. […] Therapy options are summarized in Table 4. Symptomatic support is an adequate approach for most patients. Compression bandages and limb elevation may be used for edema and pain relief. Non-steroidal anti-inflammatory drugs, such as indomethacin at 100-150 mg/day or naproxen 500 mg/day, may be used for pain control. […] In refractory disease, oral potassium iodide may be used with a dose of 300-900 mg daily divided into three doses and tapered to 150 mg/day.

• #48 Erythema nodosum

  https://www.pcds.org.uk/clinical-guidance/erythema-nodusum

  EN is usually diagnosed clinically, however, in atypical cases (eg absence of lesions on the legs, persistence or ulceration of lesions) an elliptical biopsy is needed, which shows a predominantly septal panniculitis without vasculitis. […] Most cases of erythema nodosum regress spontaneously in 34 weeks, but relapses are common. For many patients treatment is conservative and may include: […] For more prolonged / troublesome cases, a number of treatments can be used: […] Corticosteroids – can be used intralesionally or short courses given systemically. However corticosteroids must not be used if there is suspicion of TB. […] Systemic tetracyclines (doxycycline 100 mg OD or lymeycline 408mg OD), which have an anti-inflammatory effect. […] Treatments sometimes used by specialists include hydroxychloroquine and dapsone.

• #49 Erythema Nodosum: Symptoms, Causes, Diagnosis, and Treatment

  https://www.webmd.com/skin-problems-and-treatments/erythema-nodosum

  Steroids, like prednisone. Your doctor may want to make sure you don’t have a bacterial infection before they prescribe these because they can make an underlying infection worse. […] Hydroxychloroquine, cyclosporin A, or thalidomide, especially if you have IBD as an underlying condition. […] Potassium iodide or tetracycline, especially if you have symptoms that are hard to manage. Your doctor may want to make sure you don’t have a thyroid disease before they prescribe potassium iodide because it can make thyroid disease worse. […] Colchicine, especially if you have Behcet’s disease as an underlying condition.

• #50 Erythema nodosum

  https://www.pcds.org.uk/clinical-guidance/erythema-nodusum

  EN is usually diagnosed clinically, however, in atypical cases (eg absence of lesions on the legs, persistence or ulceration of lesions) an elliptical biopsy is needed, which shows a predominantly septal panniculitis without vasculitis. […] Most cases of erythema nodosum regress spontaneously in 34 weeks, but relapses are common. For many patients treatment is conservative and may include: […] For more prolonged / troublesome cases, a number of treatments can be used: […] Corticosteroids – can be used intralesionally or short courses given systemically. However corticosteroids must not be used if there is suspicion of TB. […] Systemic tetracyclines (doxycycline 100 mg OD or lymeycline 408mg OD), which have an anti-inflammatory effect. […] Treatments sometimes used by specialists include hydroxychloroquine and dapsone.

• #51 Erythema Nodosum: A Practical Approach and Diagnostic Algorithm

  https://pmc.ncbi.nlm.nih.gov/articles/PMC7938036/

  Systemic and intralesional corticosteroids are rarely used to treat EN. Prednisone 40 mg/day has been used in severe conditions. For recalcitrant nodules, intralesional triamcinolone acetonide 5 mg/mL, injected to the center of an inflamed lesion, has been used. […] Some patients respond to hydroxychloroquine 200 mg twice daily. Tetracyclines, such as minocycline 100 mg twice daily and tetracycline 500 mg every 6-12 h, have been considered as an option for chronic EN. Tumor necrosis factor- inhibitors such as etanercept, adalimumab, and infliximab have been used in patients with recalcitrant disease. Thalidomide and cyclosporine A have been used in EN associated with IBD.

• #52 A6.15 Refractory Chronic Erythema Nodosum and Treatment with Anti TNF | Annals of the Rheumatic Diseases

  https://ard.bmj.com/content/72/Suppl_1/A47.2

  Erythema nodosum septal panniculitis without vasculitis, characterised by acute episodes of inflammatory and painful subcutaneous nodules affecting, in most cases, the lower extremities. Remission of lesions occurs within 16 weeks without scarring or residual atrophy. There are, however, some cases which become chronic or reoccur. In 50% of cases we find an underlying cause. Treatment of acute outbreak involves rest and NSAIDs. The chronic or recurrent cases are treated with oral potassium iodide, cortic osteroids, colchicine, hydroxychloroquine or immunosuppressive agents. […] In our sample, all cases have responded favourably to treatment with anti TNF. No adverse events were observed, except the occurrence of cutaneous psoriasis in one patients after infliximab treatment. In reviewing the literature we find that anti TNF paradoxically brings about an immediate response in erythema nodosum patients, however provokes erythema nodosum and others skin manifestations in patients with either rheumatic pathology or inflammatory bowel disease.

• #53 Erythema nodosum – Cancer Therapy Advisor

  https://www.cancertherapyadvisor.com/home/decision-support-in-medicine/hospital-medicine/erythema-nodosum/

  There have been case reports of the use of etanercept and infliximab in adults with chronic or recurrent cases of EN. […] Other treatments more commonly used in adults include potassium iodide, colchicine, hydroxychloroquine, cyclosporin A, and thalidomide. Mainly these treatment modalities are targeted at treating the underlying systemic cause.

• #54

  https://link.springer.com/article/10.1007/s40257-021-00592-w

  Treatment of erythema nodosum with colchicine. […] Dapsone for treatment of erythema nodosum. […] Hydroxychloroquine in the treatment of chronic erythema nodosum. […] Adverse events during oral colchicine use: a systematic review and meta-analysis of randomised controlled trials. […] Etanercept treatment of erythema nodosum. […] Refractory chronic erythema nodosum treated with adalimumab. […] Treatment of chronic erythema nodosum with infliximab.

• #55 A6.15 Refractory Chronic Erythema Nodosum and Treatment with Anti TNF | Annals of the Rheumatic Diseases

  https://ard.bmj.com/content/72/Suppl_1/A47.2

  Erythema nodosum septal panniculitis without vasculitis, characterised by acute episodes of inflammatory and painful subcutaneous nodules affecting, in most cases, the lower extremities. Remission of lesions occurs within 16 weeks without scarring or residual atrophy. There are, however, some cases which become chronic or reoccur. In 50% of cases we find an underlying cause. Treatment of acute outbreak involves rest and NSAIDs. The chronic or recurrent cases are treated with oral potassium iodide, cortic osteroids, colchicine, hydroxychloroquine or immunosuppressive agents. […] In our sample, all cases have responded favourably to treatment with anti TNF. No adverse events were observed, except the occurrence of cutaneous psoriasis in one patients after infliximab treatment. In reviewing the literature we find that anti TNF paradoxically brings about an immediate response in erythema nodosum patients, however provokes erythema nodosum and others skin manifestations in patients with either rheumatic pathology or inflammatory bowel disease.

• #56 Erythema Nodosum: A Sign of Systemic Disease | AAFP

  https://www.aafp.org/pubs/afp/issues/2007/0301/p695.html

  Treatment also may be tailored to disease-specific regimens: steroids used in combination with hydroxychloroquine (Plaquenil), cyclosporin A (Sandimmune), or thalidomide (Thalomid) have been used to treat inflammatory bowel disease-associated erythema nodosum. NSAIDs should be avoided in treating erythema nodosum secondary to Crohn’s disease because they may trigger a flare-up or worsen an ongoing acute bout. Colchicine has been used in patients with erythema nodosum and coexisting Behet’s syndrome, with varying results.

• #57 Erythema nodosum – Dermatology Advisor

  https://www.dermatologyadvisor.com/home/decision-support-in-medicine/dermatology/erythema-nodosum-3/

  Certain cases of chronic EN respond well to hydroxychloroquine therapy; this drug may be particularly appropriate in rare cases of lupus-associated EN. Dapsone is very effective at treating certain cases of neutrophilic-mediated inflammation and neutrophilic vasculitides, and some patients with EN resistant to other treatment approaches will respond to dapsone therapy. […] Some patients with severe, refractory, recalcitrant disease may require alternative immunosuppressive and immunomodulatory agents. TNF alpha likely plays a role in sarcoidosis-associated EN and may be an important cytokine in EN in general. Thalidomide and the newer biologic TNF alpha-inhibitors have been used with success in treating limited numbers of patients with EN. Mycophenolate mofetil, cyclosporine, erythromycin, and extracorporeal monocyte granulocytapheresis have been reported to induce remission of EN in limited numbers of patients.

• #58 Erythema nodosum – Wikipedia

  https://en.wikipedia.org/wiki/Erythema_nodosum

  Erythema nodosum is self-limiting and usually resolves itself within 3-6 weeks. […] Treatment should focus on the underlying cause. Symptoms can be treated with bed rest, leg elevation, compressive bandages, wet dressings, and nonsteroidal anti-inflammatory agents (NSAIDs). […] Potassium iodide can be used for persistent lesions whose cause remains unknown. Corticosteroids and colchicine can be used in severe refractory cases. […] Thalidomide has been used successfully in the treatment of Erythema nodosum leprosum, and it was approved by the U.S. FDA for this use in July 1998. […] According to a 2009 meta-analysis, there is some evidence of benefit for both thalidomide and clofazimine in the treatment of erythema nodosum leprosum.

• #59 Erythema Nodosum: Symptoms, Causes, Diagnosis, and Treatment

  https://www.webmd.com/skin-problems-and-treatments/erythema-nodosum

  Steroids, like prednisone. Your doctor may want to make sure you don’t have a bacterial infection before they prescribe these because they can make an underlying infection worse. […] Hydroxychloroquine, cyclosporin A, or thalidomide, especially if you have IBD as an underlying condition. […] Potassium iodide or tetracycline, especially if you have symptoms that are hard to manage. Your doctor may want to make sure you don’t have a thyroid disease before they prescribe potassium iodide because it can make thyroid disease worse. […] Colchicine, especially if you have Behcet’s disease as an underlying condition.

• #60 Erythema Nodosum: Symptoms, Causes, Treatments and More

  https://www.healthline.com/health/erythema-nodosum

  If a bacterial infection caused this condition, your doctor will prescribe antibiotics to treat it. You can treat erythema nodosum that’s caused by a drug reaction by stopping the medicine. […] These medicines can help you manage pain and other symptoms until the lumps heal: nonsteroidal anti-inflammatory drugs (NSAIDs) such as aspirin, ibuprofen (Advil, Motrin), or naproxen (Aleve) (Don’t use these if you have Crohn’s disease because they could trigger a flare.), potassium iodide, oral steroids. […] Also, rest with your legs elevated and wear compression stockings while the bumps heal. And avoid irritating the bumps by wearing itchy or tight clothing. […] Erythema nodosum is treated in much the same way during pregnancy as it is in women who aren’t pregnant. However, some of the medicines like NSAIDs used to treat this condition can’t be used during pregnancy. Bed rest and compression stockings can help manage pain and other symptoms.

• #61 Erythema nodosum: presentation and treatment | Medicine Today

  https://medicinetoday.com.au/mt/2024/december/regular-series/erythema-nodosum-presentation-and-treatment

  Referral to a dermatologist for further investigation and management should be arranged for patients with EN that is chronic or recurrent or have lesions that do not respond to first-line therapy. For those with chronic EN or recalcitrant episodes, dapsone, potassium iodide, colchicine and hydroxychloroquine have shown benefit. […] Patients who develop EN during pregnancy should be referred to a dermatologist and consultation with a maternal-fetal medicine specialist considered before starting any medications.

• #62 Erythema Nodosum

  http://www.perinatology.com/exposures/Maternal/Dermatology/Erythema%20Nodosum.htm

  Treatment of EN is aimed at the underlying disease or removal of the offending drug when identified. Otherwise treatment during pregnancy is supportive and includes cool wet compresses, elevation, and rest. Acetaminophen may be used for pain relief, but nonsteroidal anti-inflammatory drugs (NSAIDs) are avoided because of their potential to cause oligohydramnios and constriction of the ductus arteriosus. […] Systemic steroids at a dosage of 1 mg per kg daily may be used for more persistent complaints if underlying infection, risk of sepsis, and malignancy have been excluded. Oral prednisone at a dosage of 60 mg every morning is a typical dose.

• #63 7 Tips for Dealing with Erythema Nodosum If You Have IBD

  https://www.bezzyibd.com/discover/managing-ibd/health-7-tips-for-dealing-with-erythema-nodosum-if-you-have-ibd/

  Erythema nodosum is one of the common complications of IBD. […] One of the recommended treatments for erythema nodosum is taking nonsteroidal anti-inflammatory drugs (NSAIDs). However, people with IBD are told to avoid NSAIDs as they may make intestinal symptoms worse. […] The good news is that often the meds you’re already taking for IBD may actually help relieve erythema nodosum symptoms. Both steroids and the biologic drug infliximab have been shown to be effective treatments of erythema nodosum. […] Compression therapy is often recommended for managing erythema nodosum symptoms. Your doctor might prescribe support stockings or compression wraps. […] For people who can’t take NSAIDs, ice therapy can be a good alternative for symptom relief. […] One of the best things you can do if you have erythema nodosum is giving your body plenty of time to rest and recover. […] It’s important to remember that while erythema nodosum can be painful and frustrating, most symptoms resolve within 2 to 4 weeks. If an IBD flare-up has triggered your erythema nodosum, the nodules and pain will likely subside when your IBD is in remission.

• #64 Erythema Nodosum: A Sign of Systemic Disease | AAFP

  https://www.aafp.org/pubs/afp/issues/2007/0301/p695.html

  Treatment also may be tailored to disease-specific regimens: steroids used in combination with hydroxychloroquine (Plaquenil), cyclosporin A (Sandimmune), or thalidomide (Thalomid) have been used to treat inflammatory bowel disease-associated erythema nodosum. NSAIDs should be avoided in treating erythema nodosum secondary to Crohn’s disease because they may trigger a flare-up or worsen an ongoing acute bout. Colchicine has been used in patients with erythema nodosum and coexisting Behet’s syndrome, with varying results.

• #65 How Erythema Nodosum Is Connected to IBD

  https://www.verywellhealth.com/erythema-nodosum-1943012

  Because erythema nodosum tends to resolve on its own, there is usually no specific treatment to help the lesions heal. Treatment is usually only needed to help control the pain caused by the lesions or in the joints. This may include cool compresses, leg elevation, and rest. […] Nonsteroidal anti-inflammatory drugs (NSAIDs) may also be helpful in providing pain relief, but they should be used with caution in people who have IBD. NSAIDs may cause a flare-up in some people with IBD, and therefore these drugs should only be used under the direct supervision of a gastroenterologist. […] Corticosteroids, potassium iodide, and antithyroid agents may also be used in severe or chronic cases of erythema nodosum. Limiting activity may also be recommended to help decrease the time it takes for the lesions and other symptoms to resolve.

• #66 7 Tips for Dealing with Erythema Nodosum If You Have IBD

  https://www.bezzyibd.com/discover/managing-ibd/health-7-tips-for-dealing-with-erythema-nodosum-if-you-have-ibd/

  Erythema nodosum is one of the common complications of IBD. […] One of the recommended treatments for erythema nodosum is taking nonsteroidal anti-inflammatory drugs (NSAIDs). However, people with IBD are told to avoid NSAIDs as they may make intestinal symptoms worse. […] The good news is that often the meds you’re already taking for IBD may actually help relieve erythema nodosum symptoms. Both steroids and the biologic drug infliximab have been shown to be effective treatments of erythema nodosum. […] Compression therapy is often recommended for managing erythema nodosum symptoms. Your doctor might prescribe support stockings or compression wraps. […] For people who can’t take NSAIDs, ice therapy can be a good alternative for symptom relief. […] One of the best things you can do if you have erythema nodosum is giving your body plenty of time to rest and recover. […] It’s important to remember that while erythema nodosum can be painful and frustrating, most symptoms resolve within 2 to 4 weeks. If an IBD flare-up has triggered your erythema nodosum, the nodules and pain will likely subside when your IBD is in remission.

• #67 Successful Treatment of Chronic Erythema Nodosum with Vitamin B12 | American Board of Family Medicine

  https://www.jabfm.org/content/18/6/567

  A 38-year-old woman presented with painful lesions on both shins that first appeared a few days earlier. […] The patient was treated with nonsteroidal anti-inflammatory drugs for having a few months without any improvement. […] After 4 weeks of twice weekly injections of vitamin B12 at a dose of 1000 mcg, there was a clear alleviation of the numbness, and the EN completely resolved without evidence of recurrence on follow-up. […] Although there is no proved causal relationship between vitamin B12 deficiency and EN, the condition completely resolved following treatment with vitamin B12 injections. […] Treatment was started with intramuscular injections of vitamin B12 at a dose of 1000 mcg twice a week. […] The patient stated that the rash, which had been present for 6 months, totally disappeared 2 to 3 weeks after initiation of vitamin B12 therapy. […] Because it seems that vitamin B12 caused resolution of EN in this case, we recommend that physicians consider testing for vitamin B12 deficiency in patients with EN.

• #68 Successful Treatment of Chronic Erythema Nodosum with Vitamin B12 | American Board of Family Medicine

  https://www.jabfm.org/content/18/6/567

  A 38-year-old woman presented with painful lesions on both shins that first appeared a few days earlier. […] The patient was treated with nonsteroidal anti-inflammatory drugs for having a few months without any improvement. […] After 4 weeks of twice weekly injections of vitamin B12 at a dose of 1000 mcg, there was a clear alleviation of the numbness, and the EN completely resolved without evidence of recurrence on follow-up. […] Although there is no proved causal relationship between vitamin B12 deficiency and EN, the condition completely resolved following treatment with vitamin B12 injections. […] Treatment was started with intramuscular injections of vitamin B12 at a dose of 1000 mcg twice a week. […] The patient stated that the rash, which had been present for 6 months, totally disappeared 2 to 3 weeks after initiation of vitamin B12 therapy. […] Because it seems that vitamin B12 caused resolution of EN in this case, we recommend that physicians consider testing for vitamin B12 deficiency in patients with EN.

• #69 Successful Treatment of Chronic Erythema Nodosum with Vitamin B12 | American Board of Family Medicine

  https://www.jabfm.org/content/18/6/567

  A 38-year-old woman presented with painful lesions on both shins that first appeared a few days earlier. […] The patient was treated with nonsteroidal anti-inflammatory drugs for having a few months without any improvement. […] After 4 weeks of twice weekly injections of vitamin B12 at a dose of 1000 mcg, there was a clear alleviation of the numbness, and the EN completely resolved without evidence of recurrence on follow-up. […] Although there is no proved causal relationship between vitamin B12 deficiency and EN, the condition completely resolved following treatment with vitamin B12 injections. […] Treatment was started with intramuscular injections of vitamin B12 at a dose of 1000 mcg twice a week. […] The patient stated that the rash, which had been present for 6 months, totally disappeared 2 to 3 weeks after initiation of vitamin B12 therapy. […] Because it seems that vitamin B12 caused resolution of EN in this case, we recommend that physicians consider testing for vitamin B12 deficiency in patients with EN.

• #70 Comprehensive Ayurvedic Erythema Nodosum Treatment | Elite Ayurveda® | Heal Naturally

  https://www.eliteayurveda.com/diseases/skin/erythema-nodosum/

  Erythema nodosum is a form of inflammatory skin condition that affects the fatty layer of the skin. […] The treatment for Erythema Nodosum at EliteAyurveda includes: As the root cause of it lies in dosha imbalances and immune responses, they are rectified, and Erythema Nodosum is managed with a treatment plan that includes detoxification by Panchakarma procedures to remove Ama from the body, intake of herbal medications to balance the doshas, maintaining a proper diet and exercise regimen, and external application of herbal lepa or oils to reduce inflammation and promote healing. This approach helps in managing the condition from its root cause and prevents recurrence. […] The treatment for Erythema nodosum includes following stages: Shodhana chikitsa (Detoxification) can be achieved using Panchakarma treatments such as Vamana, Virechana, Rakta mokshna, and others. Shamana chikitsa is achieved via the careful control of internal and external medications. To stop recurring infections and enhance immunity, use of Rasayana chikitsa (immunomodulation) is favoured. Dietary and lifestyle changes. Stress Management.

• #71 Comprehensive Ayurvedic Erythema Nodosum Treatment | Elite Ayurveda® | Heal Naturally

  https://www.eliteayurveda.com/diseases/skin/erythema-nodosum/

  Ayurvedic treatment for Erythema Nodosum involves balancing the doshas, detoxifying the body, and using herbal formulations to reduce inflammation and promote healing. Panchakarma procedures are often recommended to remove toxins and support overall health. […] Several Ayurvedic herbs are effective in managing Erythema Nodosum, including Neem (Azadirachta indica) for its anti-inflammatory and anti-bacterial properties, Turmeric (Curcuma longa) for its anti-inflammatory effects, Aloe Vera (Aloe barbadensis) for its soothing properties, and Manjishtha (Rubia cordifolia) for blood purification. […] Panchakarma is a set of detoxification therapies in Ayurveda that help cleanse the body of toxins (Ama). In the context of Erythema Nodosum, Panchakarma helps in balancing the doshas, reducing inflammation, and promoting overall health. Treatments such as Vamana (therapeutic vomiting), Virechana (purgation), and Basti (enema) are commonly used to detoxify and rejuvenate the body.

• #72 Comprehensive Ayurvedic Erythema Nodosum Treatment | Elite Ayurveda® | Heal Naturally

  https://www.eliteayurveda.com/diseases/skin/erythema-nodosum/

  Ayurveda addresses the root cause of Erythema Nodosum by focusing on balancing the doshas, detoxifying the body, and restoring the natural functions of the skin and immune system. This involves a combination of personalized diet plans, lifestyle modifications, herbal remedies, and Panchakarma therapies to cleanse the body of toxins and promote healing at a deeper level.

• #73 Erythema Nodosum — Advanced Dermatology

  https://www.advanced-dermatology.com.au/erythema-nodosum

  The first step in treatment is to treat the underlying cause if there is one, such as treating strep throat. Anti-inflammatory drugs can be used and cortisone can be taken orally or topically. To reduce inflammation, Colchicine can be used. Rest will also be needed for the skin to heal. Hot or cold compresses can be used for comfort, and elevating the sore area can be helpful. A therapeutic option is using oral potassium iodine solution that is supersaturated. Do note that this option could result in hyperthyroidism, so caution must be taken when using long term. […] CAM therapies (complementary and alternative therapies) can also be used to treat erythema nodosum. These are often used to reduce inflammation, prevent infections and boost the immune system. Do note that you should only use alternative therapies under the discretion of your doctor, as some may interact with medications and treatments also being provided. Vitamin C can help to protect against damage from the sun, but can also negatively impact other health conditions. Vitamin E can help to also protect against the sun, but will impact certain medications, such as blood thinners. Zinc will help to keep the skin healthy, but can interfere with antibiotics. High doses of zinc can be dangerous.

• #74 Erythema Nodosum – Skin Disorders – Merck Manual Consumer Version

  https://www.merckmanuals.com/home/skin-disorders/hypersensitivity-and-reactive-skin-disorders/erythema-nodosum

  Erythema nodosum usually is caused by a reaction to a medication, an infection (bacterial, fungal, or viral), or another disorder such as inflammatory bowel disease. […] People stop taking suspected medications, underlying conditions or infections are treated, and pain is relieved by bed rest, nonsteroidal anti-inflammatory drugs, and sometimes a corticosteroid. […] Leg elevation and cool compresses […] Nonsteroidal anti-inflammatory drugs (NSAIDs) for pain […] Treatment of underlying disorders […] Erythema nodosum almost always resolves on its own, and the nodules usually go away in 3 to 6 weeks without treatment. Bed rest, cool compresses, elevation of the legs, and NSAIDs may help relieve the pain caused by the nodules. Potassium iodide tablets may be given to decrease inflammation.

• #75 Erythema nodosum: Causes, symptoms, and pictures

  https://www.medicalnewstoday.com/articles/320829

  Erythema nodosum (EN) symptoms can include painful bumps under the skin on the legs, fever, fatigue, and joint swelling. Treatment may include rest, ice, and anti-inflammatory medications. […] With proper rest, most cases of EN resolve on their own within 1 to 2 months, with new sores continuing to develop or spread throughout the first few weeks. […] The treatment recommended for each case of EN depends on the cause. Underlying infections or medical conditions will also require treatment. […] Common forms of treatment for EN include: bed rest, especially if swelling and pain is severe; changing any medications that cause EN, but only at a doctors discretion; applying ice wrapped in a towel to the affected area for 15 to 20 minutes at a time, several times daily; elevating the affected area using a prop, such as a pillow; over-the-counter pain and anti-inflammatory medications; light compression stockings or supportive bandages and wraps; oral tetracycline; potassium iodide, often 400 to 900 micrograms (mcg) per day for 1 month when symptoms begin; systemic corticosteroids, often prednisone; steroid creams.

• #76 Erythema Nodosum: Symptoms, Causes & Treatment

  https://my.clevelandclinic.org/health/diseases/24565-erythema-nodosum

  Treatment varies for each person diagnosed with erythema nodosum and depends on what caused your symptoms. Treatment could include: […] Erythema nodosum can resolve on its own after a few weeks to months and doesn’t always need treatment. […] Treatment could involve taking medications to manage your symptoms, including: […] After treatment begins, you could see your symptoms of pain and swelling reduce. […] If you manage or treat the underlying condition that caused your symptoms or you stop taking medicine that caused your symptoms, you reduce your risk of having an erythema nodosum flare. […] At home, you can take over-the-counter NSAIDs for pain as directed by your healthcare provider. […] Elevating the affected area of your body helps minimize swelling. […] If your symptoms are severe and prevent you from going about your day normally, talk to your healthcare provider.

• #77 7 Tips for Dealing with Erythema Nodosum If You Have IBD

  https://www.bezzyibd.com/discover/managing-ibd/health-7-tips-for-dealing-with-erythema-nodosum-if-you-have-ibd/

  Erythema nodosum is one of the common complications of IBD. […] One of the recommended treatments for erythema nodosum is taking nonsteroidal anti-inflammatory drugs (NSAIDs). However, people with IBD are told to avoid NSAIDs as they may make intestinal symptoms worse. […] The good news is that often the meds you’re already taking for IBD may actually help relieve erythema nodosum symptoms. Both steroids and the biologic drug infliximab have been shown to be effective treatments of erythema nodosum. […] Compression therapy is often recommended for managing erythema nodosum symptoms. Your doctor might prescribe support stockings or compression wraps. […] For people who can’t take NSAIDs, ice therapy can be a good alternative for symptom relief. […] One of the best things you can do if you have erythema nodosum is giving your body plenty of time to rest and recover. […] It’s important to remember that while erythema nodosum can be painful and frustrating, most symptoms resolve within 2 to 4 weeks. If an IBD flare-up has triggered your erythema nodosum, the nodules and pain will likely subside when your IBD is in remission.

• #78 Erythema Nodosum Treatment & Management: Medical Care, Activity, Prevention

  https://emedicine.medscape.com/article/1081633-treatment

  Colchicine has been used in a few refractory cases with good results. […] Recurrence of EN following discontinuance of treatment is common, and underlying infectious disease may be worsened. […] Compression stockings may be beneficial for reducing swelling and allowing patients to maintain their normal activity level. […] Restriction of physical activities while EN is active may prevent exacerbations of the disease. […] Consultations with a dermatologist, an internist, or both may be necessary for evaluation of the underlying cause of EN. […] The course of EN is benign and self-limited. Bed rest and restriction of physical activities are encouraged during the active phase.

• #79 Erythema Nodosum: A Sign of Systemic Disease | AAFP

  https://www.aafp.org/pubs/afp/issues/2007/0301/p695.html

  Erythema nodosum tends to be self-limited. The most common approach is treatment of any underlying disorders and supportive therapy, including bed rest and avoidance of contact irritation of affected areas. Pain can be managed conservatively with nonsteroidal anti-inflammatory drugs (NSAIDs). More aggressive pain management is reserved for clinical situations that become recurrent or unusually prolonged. […] Oral potassium iodide prepared as a supersaturated solution in a dosage of 400 to 900 mg per day for one month is a therapeutic option. Potassium iodide therapy is more likely to be effective in providing symptomatic relief if begun at the onset of the erythema nodosum. […] Systemic steroids have been advocated as a relatively safe therapeutic option if underlying infection, risk of bacterial dissemination or sepsis, and malignancy have been excluded by a thorough evaluation. Oral prednisone at a dosage of 60 mg every morning is typical. A general rule is 1 mg per kg body weight per day.

• #80 Erythema Nodosum – StatPearls – NCBI Bookshelf

  https://www.ncbi.nlm.nih.gov/books/NBK470369/

  Extended rest is desirable and may require work stoppage. Analgesics are prescribed on request. Venous compression reduces the pain felt in orthostatism. Steroidal anti-inflammatory drugs, colchicine (1 to 2 mg/day), may be prescribed until symptoms improve. Etiologic treatment is essential in some cases, and antibiotic therapy is needed in case of streptococcal infection or anti-tuberculosis treatment. In the case of Lfgren syndrome, pulmonary radiographic monitoring is recommended because if mediastinal adenopathies disappear in a few months in most patients, sarcoidosis may persist in 10% of cases. […] EN is often encountered by primary care providers and nurse practitioners. While the diagnosis is clinical in most cases, sometimes a biopsy may be required to rule out another disorder. Healthcare workers should seek a consult with a dermatologist or rheumatologist if there is any doubt about the diagnosis. For the most part, the treatment is conservative with rest. Primary care clinicians should not initiate any type of medical therapy if the diagnosis is uncertain. In addition, since the diagnosis is clinical, the patient should not be subjected to unnecessary procedures. The type of laboratory workup depends on the suspected cause. While EN may be painful, it is a benign disorder that usually remits spontaneously. If the primary disorder is not managed, EN may persist for months or even years. The pharmacist should ensure that the patient is on no medication that causes EN. If the female is on an oral contraceptive, then an alternative form of contraception should be recommended. The primary care clinicians should communicate with the dermatologist to ensure that the patient is receiving the optimal level of care.

• #81 Erythema Nodosum: Symptoms, Causes & Treatment

  https://my.clevelandclinic.org/health/diseases/24565-erythema-nodosum

  Treatment varies for each person diagnosed with erythema nodosum and depends on what caused your symptoms. Treatment could include: […] Erythema nodosum can resolve on its own after a few weeks to months and doesn’t always need treatment. […] Treatment could involve taking medications to manage your symptoms, including: […] After treatment begins, you could see your symptoms of pain and swelling reduce. […] If you manage or treat the underlying condition that caused your symptoms or you stop taking medicine that caused your symptoms, you reduce your risk of having an erythema nodosum flare. […] At home, you can take over-the-counter NSAIDs for pain as directed by your healthcare provider. […] Elevating the affected area of your body helps minimize swelling. […] If your symptoms are severe and prevent you from going about your day normally, talk to your healthcare provider.

• #82 Erythema Nodosum: A Practical Approach and Diagnostic Algorithm

  https://pmc.ncbi.nlm.nih.gov/articles/PMC7938036/

  Erythema nodosum is the most common form of panniculitis and is characterized by tender erythematous nodules mainly in the lower limbs on the pretibial area. […] Several treatment options for the erythema nodosum lesions have been previously reported; nevertheless, these options treat the symptoms, but not the triggering cause. Making an accurate diagnosis will allow the physician to treat the underlying cause and determine an optimal therapeutic strategy. […] Therapy options are summarized in Table 4. Symptomatic support is an adequate approach for most patients. Compression bandages and limb elevation may be used for edema and pain relief. Non-steroidal anti-inflammatory drugs, such as indomethacin at 100-150 mg/day or naproxen 500 mg/day, may be used for pain control. […] In refractory disease, oral potassium iodide may be used with a dose of 300-900 mg daily divided into three doses and tapered to 150 mg/day.

• #83 Erythema nodosum – Dermatology Advisor

  https://www.dermatologyadvisor.com/home/decision-support-in-medicine/dermatology/erythema-nodosum-3/

  The management of EN is two-fold: first, identify whether there is an underlying trigger, and remove or treat that condition as necessary. In cases of medication-induced EN, removing the inciting agent may lead to spontaneous remission. Infection-associated EN will often respond to therapy targeted at the underlying infectious process. In many systemic conditions associated with EN, controlling the underlying disease will lead to improvement and resolution of EN. It is worth re-emphasizing that many cases of EN will improve and often resolve on their own; while recurrences are not uncommon, the lesions themselves are often self-limited and resolve without sequelae of atrophy or scarring. […] Treatment options for EN are summarized in the Table. When deciding on a specific therapy to target EN itself, it is essential to weigh patient-specific risks and benefits for each option. Notably many of the suggested treatments are not safe to use in pregnancy, and the importance of ruling that out prior to initiating therapy is re-emphasized. Additionally, many of the therapeutic options have been described as potential causative agents of EN; in cases where a drug is suspect, neither that drug nor members of that drug class are suggested in the management of drug-related EN. In cases where malignancy or infection is suspected, immunosuppressive medications should be avoided.

• #84 Erythema Nodosum – Skin Disorders – Merck Manual Consumer Version

  https://www.merckmanuals.com/home/skin-disorders/hypersensitivity-and-reactive-skin-disorders/erythema-nodosum

  Erythema nodosum usually is caused by a reaction to a medication, an infection (bacterial, fungal, or viral), or another disorder such as inflammatory bowel disease. […] People stop taking suspected medications, underlying conditions or infections are treated, and pain is relieved by bed rest, nonsteroidal anti-inflammatory drugs, and sometimes a corticosteroid. […] Leg elevation and cool compresses […] Nonsteroidal anti-inflammatory drugs (NSAIDs) for pain […] Treatment of underlying disorders […] Erythema nodosum almost always resolves on its own, and the nodules usually go away in 3 to 6 weeks without treatment. Bed rest, cool compresses, elevation of the legs, and NSAIDs may help relieve the pain caused by the nodules. Potassium iodide tablets may be given to decrease inflammation.

• #85 Erythema Nodosum Treatment & Management: Medical Care, Activity, Prevention

  https://emedicine.medscape.com/article/1081633-treatment

  In most patients, erythema nodosum (EN) is a self-limited disease that requires only symptomatic relief in the form of analgesics, cool wet compresses, elevation, and bed rest. If an underlying disease or drug is identified as the cause of EN, it should be eliminated. […] Given that EN often regresses spontaneously, relief of symptoms through administration of nonsteroidal anti-inflammatory drugs (NSAIDs; eg, acetylsalicylic acid, ibuprofen, naproxen, and indomethacin) may be the only treatment necessary. Corticosteroids are effective but are seldom necessary in self-limited disease. Potassium iodide has been used with the aim of alleviating lesional tenderness, arthralgia, and fever. However, a study that included nine patients with EN found that only five of the nine derived benefit from potassium iodide and that the remaining four derived no benefit at all.

• #86 Erythema nodosum: MedlinePlus Medical EncyclopediaLock

  https://medlineplus.gov/ency/article/000881.htm

  The underlying infection, drug, or disease should be identified and treated. […] Treatment may include: […] Nonsteroidal anti-inflammatory drugs (NSAIDs). […] Stronger anti-inflammatory medicines called corticosteroids, taken by mouth or given as a shot. […] Potassium iodide (SSKI) solution, most often given as drops added to orange juice. […] Other oral medicines that work on the body’s immune system. […] Pain medicines (analgesics). […] Rest. […] Raising the sore area (elevation). […] Hot or cold compresses to help reduce discomfort.

• #87 Erythema nodosum – UpToDate

  https://www.uptodate.com/contents/erythema-nodosum

  Erythema nodosum (EN) is a delayed-type hypersensitivity reaction that most often presents as erythematous, tender nodules on the shins. […] When necessary, treatment can be given to reduce symptoms or hasten resolution. […] First-line therapy includes nonsteroidal anti-inflammatory drugs and potassium iodide. […] Second-line therapy includes systemic glucocorticoids and intralesional corticosteroid injections. […] For recalcitrant, chronic, or recurring disease, dapsone, colchicine, and hydroxychloroquine may be used.

• #88 Erythema Nodosum: A Sign of Systemic Disease | AAFP

  https://www.aafp.org/pubs/afp/issues/2007/0301/p695.html

  Erythema nodosum tends to be self-limited. The most common approach is treatment of any underlying disorders and supportive therapy, including bed rest and avoidance of contact irritation of affected areas. Pain can be managed conservatively with nonsteroidal anti-inflammatory drugs (NSAIDs). More aggressive pain management is reserved for clinical situations that become recurrent or unusually prolonged. […] Oral potassium iodide prepared as a supersaturated solution in a dosage of 400 to 900 mg per day for one month is a therapeutic option. Potassium iodide therapy is more likely to be effective in providing symptomatic relief if begun at the onset of the erythema nodosum. […] Systemic steroids have been advocated as a relatively safe therapeutic option if underlying infection, risk of bacterial dissemination or sepsis, and malignancy have been excluded by a thorough evaluation. Oral prednisone at a dosage of 60 mg every morning is typical. A general rule is 1 mg per kg body weight per day.

• #89 Erythema Nodosum: A Practical Approach and Diagnostic Algorithm

  https://pmc.ncbi.nlm.nih.gov/articles/PMC7938036/

  Systemic and intralesional corticosteroids are rarely used to treat EN. Prednisone 40 mg/day has been used in severe conditions. For recalcitrant nodules, intralesional triamcinolone acetonide 5 mg/mL, injected to the center of an inflamed lesion, has been used. […] Some patients respond to hydroxychloroquine 200 mg twice daily. Tetracyclines, such as minocycline 100 mg twice daily and tetracycline 500 mg every 6-12 h, have been considered as an option for chronic EN. Tumor necrosis factor- inhibitors such as etanercept, adalimumab, and infliximab have been used in patients with recalcitrant disease. Thalidomide and cyclosporine A have been used in EN associated with IBD.

• #90 Erythema nodosum – UpToDate

  https://www.uptodate.com/contents/erythema-nodosum

  Erythema nodosum (EN) is a delayed-type hypersensitivity reaction that most often presents as erythematous, tender nodules on the shins. […] When necessary, treatment can be given to reduce symptoms or hasten resolution. […] First-line therapy includes nonsteroidal anti-inflammatory drugs and potassium iodide. […] Second-line therapy includes systemic glucocorticoids and intralesional corticosteroid injections. […] For recalcitrant, chronic, or recurring disease, dapsone, colchicine, and hydroxychloroquine may be used.

• #91 Erythema nodosum: presentation and treatment | Medicine Today

  https://medicinetoday.com.au/mt/2024/december/regular-series/erythema-nodosum-presentation-and-treatment

  Referral to a dermatologist for further investigation and management should be arranged for patients with EN that is chronic or recurrent or have lesions that do not respond to first-line therapy. For those with chronic EN or recalcitrant episodes, dapsone, potassium iodide, colchicine and hydroxychloroquine have shown benefit. […] Patients who develop EN during pregnancy should be referred to a dermatologist and consultation with a maternal-fetal medicine specialist considered before starting any medications.

• #92 Erythema nodosum – Dermatology Advisor

  https://www.dermatologyadvisor.com/home/decision-support-in-medicine/dermatology/erythema-nodosum-3/

  Certain cases of chronic EN respond well to hydroxychloroquine therapy; this drug may be particularly appropriate in rare cases of lupus-associated EN. Dapsone is very effective at treating certain cases of neutrophilic-mediated inflammation and neutrophilic vasculitides, and some patients with EN resistant to other treatment approaches will respond to dapsone therapy. […] Some patients with severe, refractory, recalcitrant disease may require alternative immunosuppressive and immunomodulatory agents. TNF alpha likely plays a role in sarcoidosis-associated EN and may be an important cytokine in EN in general. Thalidomide and the newer biologic TNF alpha-inhibitors have been used with success in treating limited numbers of patients with EN. Mycophenolate mofetil, cyclosporine, erythromycin, and extracorporeal monocyte granulocytapheresis have been reported to induce remission of EN in limited numbers of patients.

• #93 Erythema Nodosum – StatPearls – NCBI Bookshelf

  https://www.ncbi.nlm.nih.gov/books/NBK470369/

  Extended rest is desirable and may require work stoppage. Analgesics are prescribed on request. Venous compression reduces the pain felt in orthostatism. Steroidal anti-inflammatory drugs, colchicine (1 to 2 mg/day), may be prescribed until symptoms improve. Etiologic treatment is essential in some cases, and antibiotic therapy is needed in case of streptococcal infection or anti-tuberculosis treatment. In the case of Lfgren syndrome, pulmonary radiographic monitoring is recommended because if mediastinal adenopathies disappear in a few months in most patients, sarcoidosis may persist in 10% of cases. […] EN is often encountered by primary care providers and nurse practitioners. While the diagnosis is clinical in most cases, sometimes a biopsy may be required to rule out another disorder. Healthcare workers should seek a consult with a dermatologist or rheumatologist if there is any doubt about the diagnosis. For the most part, the treatment is conservative with rest. Primary care clinicians should not initiate any type of medical therapy if the diagnosis is uncertain. In addition, since the diagnosis is clinical, the patient should not be subjected to unnecessary procedures. The type of laboratory workup depends on the suspected cause. While EN may be painful, it is a benign disorder that usually remits spontaneously. If the primary disorder is not managed, EN may persist for months or even years. The pharmacist should ensure that the patient is on no medication that causes EN. If the female is on an oral contraceptive, then an alternative form of contraception should be recommended. The primary care clinicians should communicate with the dermatologist to ensure that the patient is receiving the optimal level of care.

• #94 Erythema Nodosum | Doctor

  https://patient.info/doctor/erythema-nodosum-pro

  Most cases are self-limiting and require only symptomatic relief. […] If an aetiology has been discovered then appropriate therapy is in order, depending on the underlying condition. […] A degree of relief can be obtained with cool compresses and bed rest with elevation of the foot of the bed. Bed rest has been advocated for many years and is anecdotally useful but the evidence base is lacking. […] Non-steroidal anti-inflammatory drugs (NSAIDs) and colchicine are useful and no other drugs are usually needed. Steroids are beneficial but should be used with caution and may be contra-indicated if infection has not been excluded. […] The literature on erythema nodosum lists a host of possible treatments for persisting cases – these include potassium iodide, oral steroids, tetracyclines, macrolides and biologic drugs; however, it would seem wise to involve secondary care at this point to be sure that an underlying diagnosis isn’t being missed.

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