Estimated reading time: 5 minutes
Medically reviewed and verified by Kate Burke, MD, MHA
Have painful red or blue bumps appearing on your skin? That could be a sign of erythema nodosum (EN), a painful skin condition that can affect people with inflammatory bowel disease (IBD), including ulcerative colitis. EN can also be present in patients with infections, or from reactions to medications and sarcoidosis. EN shows up in about 3–10% of people with UC, is more common in adults than children, and more common in women than men. Skin conditions can be frustrating to deal with, impacting you physically and mentally. Having an understanding of this symptom and how to manage it is an important step. Here, PatientsLikeMe will look at what the condition erythema nodosum is, why it develops, its link to ulcerative colitis, and how it is treated.
What is Erythema Nodosum?
Erythema nodosum is a type of inflammation that happens in the fatty layer under the skin. It presents as tender, red or blue, and sometimes swollen nodules or bumps. Most commonly it will appear on the lower legs, although it can show up on the arms, knees, and very rarely the face or neck. These nodules can be anywhere from 3–20 cm in diameter.
Symptoms
Erythema nodosum often starts with flu-like symptoms, such as a fever, fatigue, and joint pain. The nodules themselves are initially red and tender, becoming darker, hard, or bruise-like over time. Over the course of several weeks the condition will change.
- Week 1: Red, tender, and swollen nodules appear.
- Week 2: Nodules harden and may turn bluish or feel like they contain fluid.
- Week 3: Lesions fade, turning yellowish or green, like a healing bruise.
The lesions can cause discomfort, especially if they are on weight-bearing areas like the legs. Swollen and painful ankles are common, and in some cases, other joints like the knees may also be affected.
Why Does Erythema Nodosum Happen?
Erythema nodosum is a reaction to inflammation. It is considered a symptom of an underlying condition rather than a standalone disease. For people with ulcerative colitis, the skin condition often happens when they have a flare-up of their intestinal symptoms. This means it is linked to the body's immune response and gets better when the UC is brought under control.
Other potential causes can be:
- Infections.
- Medications like sulfa drugs, bromides, and oral contraceptives.
- Other diseases like sarcoidosis, histoplasmosis, and cancer.
- Pregnancy.
Erythema Nodosum and Ulcerative Colitis
For people with ulcerative colitis, erythema nodosum is an important skin symptom to watch for! While it’s more commonly seen in Crohn’s disease, it can still affect many people with UC. It tends to happen during flare-ups, so managing ulcerative colitis effectively is key to preventing or relieving the condition.
Diagnosis
In most cases, erythema nodosum is diagnosed based on its appearance and symptoms. This is especially true for someone already diagnosed with ulcerative colitis or another form of IBD. If the condition happens in someone without a known underlying disease, doctors may order additional tests, like:
- Blood tests to check for inflammation.
- X-rays to rule out infections or other conditions.
- Skin biopsy to confirm the diagnosis.
Treatment
Erythema nodosum may resolve on its own without requiring too much treatment. However, there can be significant discomfort caused by the nodules, which can make management necessary. Treatment focuses on relieving symptoms and addressing the underlying cause. A doctor may recommend rest and elevation to start. Elevating your legs and resting can reduce swelling and pain. Putting cool compresses on the nodules can relieve discomfort. If you are in pain, over-the-counter medications such as acetamenopthen can help. However, people with UC should be cautious around which medications they take. Do not take any medicine without first talking to your doctor.
Medications
Some common medications used to treat the condition are:
- NSAIDs: Nonsteroidal anti-inflammatory drugs may help reduce pain but can trigger flare-ups in people with ulcerative colitis. Always talk to a gastroenterologist before using these drugs.
- Corticosteroids: For severe or prolonged cases, oral steroids like prednisone may be prescribed to reduce inflammation.
- Potassium Iodide: This treatment can provide symptom relief when used early.
If you have ulcerative colitis, it is important to stay on the lookout for symptoms like erythema nodosum. This condition is a signal that your body’s inflammation levels are elevated, which could mean your ulcerative colitis needs better management. Keep your UC under control with regular check-ins and adjustments to your treatment plan as needed. Be aware of early signs of erythema nodosum and report them to your doctor promptly. A balanced diet, regular exercise, and stress management can help reduce the frequency of flare-ups, potentially preventing erythema nodosum.
Erythema nodosum is a common skin complication of ulcerative colitis and other inflammatory bowel diseases. While it can be painful and uncomfortable, it may resolve on its own and improve with proper management of the underlying condition. If you have red, tender nodules on your legs or other areas, get medical advice quickly to confirm the diagnosis and receive appropriate care.
Take control of your health with PatientsLikeMe, a revolutionary platform designed to help you manage your wellness journey effectively. Connect with others who share similar experiences and gain access to valuable insights and support tailored to your health needs. Start your journey to better health today with PatientsLikeMe!