Approach

The main task of the clinician is to identify and treat the primary cause. Many lesions in young patients resolve spontaneously in 1 to 2 months.[22][3]

Mild to moderate symptoms

In patients with fever and troublesome arthralgias, symptoms can be controlled by bed rest, leg elevation, and nonsteroidal anti-inflammatory drugs (NSAIDs). The risk of deep vein thrombosis can be assessed if appropriate and compression stockings used if necessary.

Severe and refractory symptoms

In more severe or unresponsive cases, oral potassium iodide has been used successfully. While the mechanism of action of potassium iodide is unknown, it is postulated that it affects neutrophil chemotaxis or neutrophil chemotoxicity.[23]

For persistent painful lesions, intralesional corticosteroid injections can be beneficial, but these are limited by procedural discomfort.

Systemic corticosteroids may be required if symptoms are severe or unresponsive, but should be avoided until the underlying cause is established, and then used in tapering courses over several weeks. Patients receiving prolonged therapy may be at risk for reactivation of tuberculosis and fungal infection, and sepsis may result if an underlying bacterial infection is overlooked.[24][25][26]

Treatment of underlying disorders

In people over 35 years old, erythema nodosum can be chronic and may be triggered by a more serious underlying disorder, such as rheumatoid arthritis or ulcerative colitis.[1][2]

Patients who have tuberculosis, brucellosis, or other underlying infections should receive the appropriate therapy.

Patients with sarcoidosis who develop erythema nodosum have a good prognosis and generally do not require corticosteroids, but they do require frequent monitoring to assess the disease course.

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