Medically reviewed by Dr. A.M. van Coevorden, dermatologist
Erythema nodosumPainful red nodules, usually on the shins.
Erythema nodosum is an inflammation of the fat cells beneath the skin. Painful, warm, red nodules appear suddenly, usually on the front of both lower legs. You often feel ill with it. The inflammation is the body's reaction to a trigger, such as a recent infection, a medicine or an underlying disease; often no cause is found. The nodules clear by themselves, but an assessment by a doctor is always needed.
What is erythema nodosum?
On the legs, usually on the front of both shins, very painful, warm, red lumps of one to five centimetres appear suddenly, sometimes merging into larger patches. The lower legs and ankles are often somewhat swollen. Many people feel ill with it, with fever, tiredness, headache or painful joints. Over a period of three to six weeks new nodules can appear; older patches turn blue and yellow, like a bruise, and then disappear without scars. Erythema nodosum mainly affects women between 15 and 40.
How does erythema nodosum develop?
The nodules are a reaction pattern: the immune system responds to a trigger elsewhere in the body, and that reaction settles as inflammation in the fat beneath the skin. Known triggers are a recent infection, such as a streptococcal throat infection, certain medicines, and underlying diseases such as sarcoidosis or Crohn's disease; pregnancy can also play a role. In a large proportion of people no cause is found. Erythema nodosum is not contagious.
What can you do yourself?
Rest is the most important thing: take it easy and keep the legs elevated as much as possible. Compression stockings or bandages ease the pain and the swelling. Cooling can feel pleasant. The nodules heal by themselves; self-care makes the weeks until recovery more bearable but does not substantially speed up the process. For the pain, the doctor can advise a painkiller.
When to see a dermatologist or doctor?
Always have erythema nodosum assessed, even though it clears by itself. The doctor confirms the diagnosis from the picture and looks for the trigger behind it: sometimes the nodules point to an infection or an underlying disease that itself needs treatment. A dermatologist can review if there is doubt about the picture; painful red patches on the lower leg can also fit other conditions, such as erysipelas, which needs a very different treatment.
Please note
Sudden painful, warm, red nodules on your shins, especially with fever or feeling ill? Make an appointment with your GP: an underlying cause always needs to be looked into.
Frequently asked questions
Is erythema nodosum dangerous?
The nodules themselves are not: they heal by themselves, without scars. Erythema nodosum can, however, be a signal of something else, such as an infection or an underlying disease. That is why an assessment by a doctor is always part of it.
How long does erythema nodosum last?
Over a period of three to six weeks new nodules can appear, while older patches discolour like a bruise and disappear. Everything is usually gone within a few weeks to two months. Tiredness can last somewhat longer.
Where does erythema nodosum come from?
It is a reaction of the immune system to a trigger, such as a recent throat infection, a medicine or an underlying disease such as sarcoidosis or Crohn's disease. In a large proportion of people no cause is found.
What helps against the pain of erythema nodosum?
Rest, elevating the legs and compression stockings or bandages ease the pain and swelling the most. The doctor can also advise a painkiller. The nodules heal by themselves; patience is part of the treatment.
When should you see a doctor about these nodules?
Always: erythema nodosum deserves an assessment because an underlying cause can sit behind it. Go quickly if you have a fever, feel ill or if the redness spreads rapidly; the latter can also fit erysipelas, which needs immediate treatment with antibiotics.
Sources and more information
- Erythema nodosum (nvdv.nl)