Treatment of Erythema Nodosum
The treatment of erythema nodosum focuses on reducing inflammation, relieving pain, and addressing the underlying cause. Erythema nodosum usually resolves on its own within three to six weeks, but treatment helps manage symptoms and prevent recurrence.
Rest and Supportive Care
For most patients, the main treatment includes:
Rest and leg elevation, especially during painful flare-ups
Cool compresses, to reduce inflammation
Compression stockings, to support circulation and minimise swelling
Avoiding prolonged standing or walking, especially in the acute phase
These basic steps can make a significant difference in comfort levels.
Pain and Inflammation Relief
To ease symptoms:
Doctors commonly prescribe non-steroidal anti-inflammatory drugs (NSAIDs) such as ibuprofen or naproxen.
Paracetamol can be used for fever or general discomfort
In severe cases, doctors may prescribe oral corticosteroids like prednisone for short-term use—but only if there is no infection, such as tuberculosis
Doctors should never start corticosteroids until they have ruled out infections like TB, as these medications can worsen the disease.
Treating the Underlying Cause
Identifying and addressing the trigger is crucial:
Antibiotics, for streptococcal infections
Anti-TB medication, if tuberculosis is confirmed
Doctors stop the responsible medication if they suspect a drug-induced reaction
Doctors prescribe immunosuppressants only when erythema nodosum is linked to autoimmune diseases like sarcoidosis or inflammatory bowel disease, and even then, only in rare cases.
Recurrent Cases
For patients with frequent episodes:
Long-term NSAID therapy may be considered under supervision
Colchicine or potassium iodide is occasionally used
Antiviral or antimicrobial suppression may help if the cause is infectious
Lifestyle adjustments, such as managing weight and avoiding known triggers, may also reduce recurrence.
Treatment of Erythema Nodosum In South Africa
In South Africa, TB-related erythema nodosum is common. Patients may start TB treatment based on chest X-ray and clinical suspicion. Public hospitals often provide NSAIDs and basic wound care supplies, while doctors reserve corticosteroids for non-infectious cases after thorough evaluation.
Doctors often treat erythema nodosum straightforwardly, tailoring the treatment to each individual. Identifying and resolving the underlying cause leads to a faster recovery and prevents repeated flare-ups.
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