Erythema Nodosum

Inflammation of the skin that shows up as painful reddish tender lumps is called Erythema nodosum. This inflammation is usually located in a part of the fatty layer of skin (subcutaneous fat). The size of the lump could vary in size from 1 to 5 cm. The inflammation causes nodular swelling. The inflammation remains for about a week and then becomes flat leaving behind a bruised appearance. They usually show up on the shins (front portion of the legs, just below the knee). Erythema nodosum is a type of panniculitis, i.e. inflammation that can cause nodules below the surface of the skin. The condition is more common among youngsters aged between 12-20 years.

Erythema nodosum settles down on its own after a period of three to six weeks. It may leave behind a temporary bruised appearance or a chronic indentation in the part where the fatty layer has been injured. Though the condition is annoying and painful, the condition does not cause any damage to the internal organs of our body. In adults, the condition is more often seen in women than in men. In kids, it affects boys and girls equally. In a few people the trigger can be identified and in yet a few it cannot be identified. However identifying the trigger becomes very important as it needs to be treated.

Erythema nodosum causes

Erythema nodosum may show up on its own or may occur in association with other conditions. In about 30-50% of cases, the cause is unknown. However the common triggers that may cause Erythema nodosum include:

• Step throat (streptococcal infection) in adults and kids
  
• Fungal diseases
  
• Tuberculosis
  
• Cat scratch disease
  
• Few medications like penicillin, oral contraceptive, Hepatitis B vaccination, etc
  
• Sarcoidosis
  
• Inflammatory bowel diseases
  
• Behcet's disease
  
• Pregnancy
  
• Certain types of cancers like lymphoma, leukemia, etc

Erythema nodosum symptoms

• Painful nodules are commonly seen on the shin and sometimes on the arms, thighs and trunk of the body. The nodule when it first appears is red, hot and firm to touch and becomes flat over a few days. It appears as bruise that is blue in color and later turns yellowish as it fades. A person may develop just a couple of nodules or much more.
  
• Flu-like feeling before the appearance of lumps.
  
• Aching joints and legs before the appearance of lumps. Ankle, knee and wrist joints are the most affected.
  
• Loss of weight.
  
• Symptoms may vary depending on the underlying trigger that caused the condition.

Erythema nodosum diagnosis

• By means of physical examination
  
• Biopsy of the affected area
  
• Blood test to identify the trigger
  
• Chest X-ray in case of TB or sarcoidosis induced condition
  
• Throat swab

Erythema nodosum treatment

• Cortisone injection
  
• Oral cortisone
  
• Anti-inflammatory drugs
  
• Bed rest
  
• Compression bandages
  
• Cool wet compresses
  

Erythema Multiforme

Erythema Multiforme is a skin condition arising from an allergic reaction. It is an acute but usually self-limiting skin inflammation. Erythema multiforme derives it's name from the fact that it appears in many forms. Erythema multiforme minor is a relatively milder attack. It lasts for a couple of weeks. On the other hand, Erythema multiforme major (also known as Stevens Johnson syndrome) is a severe allergic reaction resulting in large blood blisters. Usually the cause of Erythema multiforme is the herpes virus. It may be caused by bacterial or viral infections and can sometimes be a reaction to medication.

Erythema multiforme manifests as skin lesions - red welts with purple areas in the center. The rashes appear all over the body and also affect the mouth and eyes. There is burning or itching. The rash may be more localized on the hands and feet. Some patients suffering from Erythema multiforme tend to get repeated attacks. There may be fever and joint ache. As the rashes disappear, they may leave a brown pigmentation on the skin. This skin condition is mostly seen in children and young adults.

Most cases of erythema multiforme completely recover. The condition is diagnosed by a dermatologist by the typical rash associated with it. Erythema multiforme is treated with steroid creams and tablets. Antibiotics are prescribed for any secondary infection. If herpes simplex virus is identified as the cause, antiviral agents such as aciclovir or Valvir is prescribed.

Stevens Johnson Syndrome

Stevens Johnson Syndrome or SJS is a potentially deadly skin condition with symptoms similar to erythema multiforme but in a much more severe and extensive manner.

SJS, depending upon the severity is also known as Toxic Epidermal Necrolysis (TEN) - a violent reaction that comes after exposure to some drugs like allopurinol, sulfonamide antibiotics, lamotrigine, carbamazepine, nevirapine and phenytoin.

SJS can affect any age group, particularly older people. It can be caused by a drug hypersensitivity. A patient with impaired immune system like HIV, or one who is undergoing radiation therapy has higher chances of SJS. Stevens Johnson syndrome symptoms include flu-like symptoms in addition to the rashes. There is blistering on the skin and mucus membranes. Infection that enters through the blistered and affected areas can be deadly and life-threatening. The patient may develop red eyes and joint pains. The skin lesions are often referred to as target lesions since they are characterized by concentric rings of red, white and red. Conjunctivitis is sometimes noticed. Treatment for Stevens-Johnson syndrome include topical anesthetics, corticosteroids and antibiotics. Usually the patients suffering from this condition are hospitalized. It may take a few weeks for a patient to recover from SJS.