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Erythema Nodosum, Emergency Medicine

Herbert G. Bivins Reviewed 06/2017



  • Erythema nodosum (EN) is characterized by multiple symmetric, nonulcerative tender nodules on the extensor surface of the lowerextremities, typically in young adults.

  • Peak incidence i...


Signs and Symptoms

  • Tender erythematous nodules symmetrically distributed on extensor surface of lower legs

  • Lesions occasionally occur on fingers, hands, arms, calves, and thighs.

  • In bedridden p...


  • Rare in children, S. pharyngitis is the most likely etiology.

  • Catscratch disease should be considered.


Maintain universal precautions 

Initial Stabilization/Therapy

Airway, breathing...



Admission Criteria

Dictated by the severity of symptoms and the etiologic agent 

Discharge Criteria

  • Nontoxic patients, able to take PO fluids without difficulty

  • Scheduled follow-up sh...

Pearls and Pitfalls

  • EN is usually idiopathic but may be the 1st sign of systemic disease.

  • Lesions may recur if underlying disease is not treated.

  • Atypical and chronic lesions may indicate an alternative...

Additional Reading

  • Gilchrist  H, Patterson  JW. Erythema nodosum and erythema induratum (nodular vasculitis): Diagnosis and management. Dermatol Ther.  2010;23(4):320–327.

  • James  JD, Berger  TG, E...



  • 017.10 Erythema nodosum with hypersensitivity reaction in tuberculosis, unspecified

  • 695.2 Erythema nodosum


  • A18.4 Tuberculosis of skin and subcutaneous tissue

  • L52 Erythema nodosum


  • 3286...

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