Erythema Nodosum

An erythematous eruption commonly associated with drug reactions or infection and characterized by inflammatory nodules that are usually tender, multiple, and bilateral. These nodules are located predominantly on the shins with less common occurrence on the thighs and forearms. They undergo characteristic color changes ending in temporary bruise-like areas. This condition usually subsides in 3-6 weeks without scarring or atrophy.

Networked: 666 relevant articles (46 outcomes, 40 trials/studies)

Relationship Network

Disease Context: Research Results

Related Diseases

1.	Leprosy (Hansen's Disease)
2.	Aphthous Stomatitis (Aphthous Ulcer)
3.	Arthralgia (Joint Pain)
4.	Graft vs Host Disease (Graft-Versus-Host Disease)
5.	Crohn Disease (Crohn's Disease)

Experts

1.	Gonzalez-Gay, M A: 5 articles (01/2009 - 12/2001)
2.	Amoli, M M: 5 articles (01/2009 - 12/2001)
3.	Dogra, Sunil: 4 articles (09/2015 - 12/2007)
4.	Rea, Thomas H: 4 articles (10/2014 - 09/2002)
5.	Mahajan, Vikram K: 4 articles (01/2011 - 06/2003)
6.	Hsu, Sylvia: 4 articles (07/2010 - 08/2003)
7.	Ollier, W E R: 4 articles (01/2009 - 03/2004)
8.	Sampaio, E P: 4 articles (02/2002 - 11/2000)
9.	Sarno, Euzenir N: 3 articles (01/2012 - 11/2002)
10.	Ollier, William E R: 3 articles (01/2011 - 02/2004)

Drugs and Biologics

Drugs and Important Biological Agents (IBA) related to Erythema Nodosum:

1.	Thalidomide (Thalomid)FDA Link 08/01/1976 - "Reactive episodes continue to be a serious complication, but the availability of thalidomide to control erythema nodosum leprosum has markedly improved the prognosis. " 04/01/2010 - "Thalidomide (Thal) provides effective treatment for erythema nodosum leprosum (ENL). " 12/15/2005 - "Effective treatment of erythema nodosum leprosum with thalidomide is associated with immune stimulation." 10/20/2001 - "In 1964 it was discovered that thalidomide was effective against erythema nodosum leprosum. " 03/01/1998 - "The efficacy of thalidomide in the treatment of erythema nodosum leprosum is a well established fact; there is also accumulating evidence of its therapeutic value in a number of other inflammatory and immune-mediated conditions. "
2.	ColchicineFDA LinkGeneric 01/01/2009 - "Oral aphthosis, genital aphthosis, pseudofolliculitis, and erythema nodosum improved significantly with colchicine but not with placebo. " 03/17/1984 - "[Treatment of erythema nodosum with colchicine]." 06/01/1983 - "Use of colchicine in the management of erythema nodosum leprosum (ENL)." 12/11/1967 - "Erythema nodosum treatment with colchicine." 11/01/2001 - "Colchicine is a widely used treatment for Behçet's syndrome, even though in a previous 6-month controlled study, it was shown to be effective only in controlling erythema nodosum and arthralgias. "
3.	Clofazimine (Lamprene)FDA Link 09/01/1971 - "Treatment of moderately severe erythema nodosum leprosum with clofazimine--a controlled trial." 03/01/2009 - "Clofazimine enterophathy is a serious complication of clofazimine when used at high doses for treatment of type 2 lepra or or erythema nodosum leprosum. " 03/01/2009 - "[Persistent type 2 lepra reaction (erythema nodosum) and clofazimine-induced lethal enteropathy]." 03/01/1995 - "A 66-year-old Indian male who had been treated for recurrent erythema nodosum leprosum with 300 mg of clofazimine per day for 11 months presented to hospital with a 4 week history of severe gastrointestinal upset. " 03/01/1990 - "Clofazimine, even in low doses, was found to suppress the frequency and severity of erythema nodosum leprosum. "
4.	Cyclosporine (Ciclosporin)FDA LinkGeneric 01/01/1994 - "Cyclosporin A is not very effective in erythema nodosum leprosum (ENL)" 09/01/1987 - "Treatment of chronic erythema nodosum leprosum with cyclosporine A produces clinical and immunohistologic remission." 12/01/1986 - "Effect of cyclosporine A in erythema nodosum leprosum." 09/01/1987 - "We have treated three leprosy patients suffering from chronic, steroid-dependent erythema nodosum leprosum (ENL) with cyclosporine A (CsA). " 02/01/2006 - "With complaints of oral and genital ulcerations and erythema nodosum, Behçet disease was diagnosed in 1995 and he was treated with colchicine and cyclosporin. "
5.	infliximab (Remicade)FDA Link 01/01/2008 - "Erythema nodosum associated with infliximab therapy." 11/01/2006 - "Treatment of chronic erythema nodosum with infliximab." 08/17/2006 - "Treatment of recurrent erythema nodosum leprosum with infliximab." 09/01/2004 - "Extraintestinal manifestations (erythema nodosum and arthralgiae) completely remitted soon after the first infusion of infliximab. " 03/01/2004 - "Failure of infliximab treatment and occurrence of erythema nodosum during therapy in two patients with Behçet's disease."
6.	Rifampin (Rifampicin)FDA LinkGeneric 04/01/2001 - "Rifampicin-induced erythema nodosum leprosum-like eruption in borderline lepromatous leprosy." 01/01/2003 - "The patient responded well to fluoroquinolone, rifampicin and clofazimine, with however, the occurrence of erythema nodosum leprosum." 12/01/1994 - "With high-dose rifampicin and clofazimine therapy, the skin changes cleared over the course of 11 months following a leprosy reaction type II (erythema nodosum leprosum) that developed during a phase of discontinued therapy due to low patient compliance." 08/01/2003 - "Under the diagnosis of leprosy (LL type) accompanied by erythema nodosum leprosum, the combined chemotherapy (clofazimine, rifampicin, and diphenyl sulfone) was started. " 12/01/1991 - " The 2nd case was a 28-year old male from Martinique who had been treated with triple therapy (dapsone, rifampin, and clofazimine) for lepromatous disease with erythema nodosum leprosum for 9 years, but later developed reactive polyarthritis and 1+ bacterial index along with generalized lymphadenopathy with his HIV. "
7.	Aspirin (Acetylsalicylic Acid)FDA LinkGeneric 08/01/2000 - "Subsequently, thalidomide was found to be highly effective in managing the cutaneous manifestations of leprosy (erythema nodosum leprosum) and even to be superior to aspirin (acetylsalicylic acid) in controlling leprosy-associated fever. " 07/01/1980 - "A patient with chronic erythema nodosum of two years' duration, who did not respond to treatment with aspirin or with phenylbutazone therapy, had a dramatic response and improvement when treated with naproxen." 03/01/1984 - "Polyethylene glycol (PEG) precipitates obtained from sera were characterized and quantitated in 20 borderline lepromatous (BL) and polar lepromatous (LL) patients with moderate to severe erythema nodosum leprosum (ENL) before and four weeks after treatment with anti-ENL drugs, e.g., cortisone, clofazimine, chloroquine, or aspirin. "
8.	Cyclophosphamide (Cytoxan)FDA LinkGeneric 07/15/2006 - "Moreover, eight patients with pyoderma gangrenosum and erythema nodosum who responded to cyclophosphamide have maintained their remission for up to 30 months. " 06/01/2011 - "Colchicine was found to be effective for mucocutaneous symptoms, thalidomide was found to be effective in erythema nodosum-like skin lesions, azathioprine and cyclosporine were shown to be effective in BD uveitis, and cyclophosphamide was shown to be effective for major vascular involvement. "
9.	Prednisolone (Predate)FDA LinkGeneric 08/01/2009 - "While tapering the dosage of prednisolone, we carefully observed the appearance of skin lesions and erythema nodosum appearing on her right lower leg. " 09/01/2004 - "Histological examination revealed erythema nodosum (EN), and the patient was treated with oral prednisolone (PSL; 20 mg daily). " 06/19/1993 - "The treatment of complications such as reversal reaction and erythema nodosum leprosum essentially involves the use of prednisolone. " 03/01/1958 - "[Prednisolone in therapy of erythema nodosum]." 09/01/2000 - "We followed the urinary levels of the metabolites of NO [nitrite (NO2-) and nitrate (NO3-)] and the clinical response to prednisolone treatment in leprosy patients (n = 9) admitted to ALERT leprosy hospital Addis Ababa, Ethiopia, because of reversal reaction (RR) or erythema nodosum leprosum (ENL). "
10.	Tumor Necrosis Factor-alpha (Tumor Necrosis Factor)IBA 11/01/2008 - "Moreover as previously described in other populations, the TNF-alpha A/A (high) genotype has a significant association with erythema nodosum." 11/01/2008 - "The TNF-alpha A/A (high) genotype is significantly associated with erythema nodosum (p=0.04). " 11/01/2000 - "Tumor necrosis factor (TNF)-alpha has been implicated as a key factor in inflammatory processes occurring in erythema nodosum leprosum (ENL). " 10/01/1994 - "However, IFN-gamma administration also resulted in the induction of erythema nodosum leprosum, a toxic syndrome associated with excess TNF-alpha production. " 08/01/2009 - "We found no association with affectation status; however, a variant in the promoter of tumor necrosis factor (TNF) at position -308 was found to be associated with erythema nodosum in Caucasian sarcoidosis patients (study-wide P=0.027). "

Therapies and Procedures

1.	Drug Therapy (Chemotherapy) 08/01/2003 - "In view of the recognized association of erythema nodosum with malignancy and the differential rate of response to chemotherapy, the lesions of erythema nodosum may be a source of a false-positive PET interpretation, and histologic assessment should be considered." 06/01/1992 - "Erythema nodosum leprosum (ENL) was induced in 60% of the patients within 6-7 mo, as compared with an incidence of 15% per year with multiple drug therapy alone. " 11/01/1987 - "Neither the prevalence nor the magnitude of plasma leucotactic inhibitory activity correlated with disease histology or duration, type or duration of chemotherapy, or history of erythema nodosum leprosum. " 04/01/1982 - "It seems that antileprosy chemotherapy precipitates erythema nodosum leprosum by interfering with immunoregulatory T cells." 04/21/1973 - "Erythema nodosum leprosum in the absence of chemotherapy."
2.	Aftercare (After-Treatment) 12/01/2003 - "Included in the study were patients who had developed nerve impairment after treatment of leprosy in the absence of relapse, erythema nodosum leprosum, or reversal reactions, and who were referred to a neurologist. " 06/01/1998 - "If all severe RR, severe erythema nodosum leprosum and silent neuropathies at the start of, during and after treatment were added together, then 53% of the borderline lepromatous and 42% of the lepromatous patients had or developed one or another serious complication in need of steroid treatment." 01/01/1996 - "Frequency, number, duration and severity of oral aphthous ulcers, genital ulcers and erythema nodosum were determined before and after treatment. " 04/28/1928 - "ERYTHEMA NODOSUM AND ACUTE ENDOCARDITIS FOLLOWING TONSILLITIS: RECOVERY AFTER TREATMENT WITH ANTISTREPTOCOUCUS SERUM." 02/01/2010 - "Three patients have been described, each representing a prototype, the first presenting as bullous erythema nodosum leprosum (ENL), second with ENL erupting after treatment for co-existing pulmonary tuberculosis and resembling immune reconstitution inflammatory syndrome, and a third patient with recurrent Sweets-syndrome like presentation who had taken incomplete MDT in the past for leprosy. "
3.	Plasma Exchange 02/13/1988 - "[Efficacy of plasma exchange in leprotic erythema nodosum]." 05/01/1986 - "Plasma exchange may also work like a regulator of immune mechanisms, since it has been shown that there is a depression of suppressor cells in erythema nodosum leprosum." 05/01/1986 - "Four patients with severe erythema nodosum leprosum were treated by plasma exchange and/or fresh frozen plasma infusions after failure of classical therapy. " 05/01/1986 - "Plasma exchange in severe erythema nodosum leprosum."
4.	Catheters 03/01/2006 - "After confirmation of Behçet's disease on the basis of a history of recurrent oral and genital ulcers and erythema nodosum, remission was achieved after treatment with methylprednisolone pulse therapy, colchicine, catheter directed thrombolysis and thrombectomy. "
5.	Thrombectomy 03/01/2006 - "After confirmation of Behçet's disease on the basis of a history of recurrent oral and genital ulcers and erythema nodosum, remission was achieved after treatment with methylprednisolone pulse therapy, colchicine, catheter directed thrombolysis and thrombectomy. "