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The morning after rash: Erythema nodosum due to emergency contraception

Erythema nodosum is a dermatologic condition that may present with nodular erythematous eruptions that is usually limited to the extensor aspects of the extremities in patients secondary to a wide array of potential conditions as well as secondary to medications. Oral contraceptives are a known, but not commonly considered cause, of EN, and should be considered in the differential in age-appropriate females presenting in the right clinical scenario with painful nodules and bruising to the lower extremities. Treatment is often conservative, however, in severe cases, prednisone can be used.

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Articles of Interest

A Case of Erythema Nodosum

We present this case to discuss the course and management of erythema nodosum. Erythema nodosum can occur secondary to various causes and this case report provides more information and understanding of how to approach an unique disorder.

Erythema Nodosum in Children: A Narrative Review and a Practical Approach

The prognosis of EN is excellent, with spontaneous resolution in most patients within 2–6 weeks. Treatment, if needed, is addressed to the underlying condition.

Erythema Nodosum: A Practical Approach and Diagnostic Algorithm

Erythema nodosum is the most common form of panniculitis and is characterized by tender erythematous nodules mainly in the lower limbs on the pretibial area. The exact cause of erythema nodosum is unknown, although it appears to be a hypersensitivity response to a variety of antigenic stimuli. Although the etiology is mostly idiopathic, ruling out an underlying disease is imperative before diagnosing primary erythema nodosum.

Erythema Nodosum: A Sign of Systemic Disease

Erythema nodosum is a type of panniculitis that affects subcutaneous fat in the skin, usually first evident as an outcropping of erythematous nodules that are highly sensitive to touch.1 Most nodules are located symmetrically on the ventral aspect of the lower extremities. Although erythema nodosum usually has no specific documented cause, it is imperative to investigate possible triggers. Streptococcal infections are the most common identifiable etiology, especially in children.

What is Erythema nodosum

Erythema nodosum (EN) is a skin condition in which red bumps (nodules) form on the shins. Less commonly, the nodules form on other areas of the body such as the thighs and forearms

Resources

British Association of Dermatologists

EN starts as poorly defined red painful lumps. They feel like firm, smooth, raised lumps, 2 to 6 cm in diameter on the skin and are often very tender. They most typically appear on the shins and around the ankles, however less commonly on the arms, thigh and neck. As the lump begins to fade, it looks more like a bruise. The lumps usually clear over a period of 3–6 weeks without scarring.

Radiopaedia

Typically the lesions are self-limiting and resolve within a few weeks. Underlying disorders however should be investigated for and treated.

StatPearls

Erythema nodosum (EN) is a common acute nodular septal panniculitis, characterized by the sudden onset of erythematous, firm, solid, deep nodules or plaques that are painful on palpation and mainly localized on extensor surfaces of the legs.

UpToDate

EN is considered a delayed-type hypersensitivity reaction resulting from exposure to various antigens; however, the pathogenesis is not fully understood.

Zero to Finals

Erythema nodosum is a condition where red lumps appear across the patient’s shins. Erythema means red and nodosum directly translates from Latin as “knots”, referring to lumps. It is caused by inflammation of the subcutaneous fat on the shins. Inflammation of fat is called panniculitis. It is caused by a hypersensitivity reaction. In around half of patients there is no identifiable cause. It is associated with a number of triggers and underlying conditions.