Article: Erythema Nodosum: A Sign of Systemic Disease

[Guest guest]

http://www.aafp.org/afp/20070301/695.html Treatment Although erythema nodosum can be

exquisitely tender, it tends to be self-limited. The most common approach is

treatment of any underlying disorders and supportive therapy, including bed

rest and avoidance of contact irritation of affected areas. Pain can be managed

conservatively with nonsteroidal anti-inflammatory drugs (NSAIDs). More

aggressive pain management is reserved for clinical situations that become

recurrent or unusually prolonged. Oral potassium iodide prepared as a supersaturated

solution in a dosage of 400 to 900 mg per day for one month is a therapeutic

option. Potassium iodide therapy is more likely to be effective in providing

symptomatic relief if begun at the onset of the erythema nodosum.28 Caution must be taken to avoid hyperthyroidism, a

risk with prolonged use. Systemic steroids have been advocated as a

relatively safe therapeutic option if underlying infection, risk of bacterial

dissemination or sepsis, and malignancy have been excluded by a thorough

evaluation. Oral prednisone at a dosage of 60 mg every morning is typical. A

general rule is 1 mg per kg body weight per day.1,3 Treatment also may be tailored to disease-specific

regimens: steroids used in combination with hydroxychloroquine (Plaquenil),

cyclosporin A (Sandimmune), or thalidomide (Thalomid) have been used to treat

inflammatory bowel disease-associated erythema nodosum. NSAIDs should be

avoided in treating erythema nodosum secondary to Crohn's disease because they

may trigger a flare-up or worsen an ongoing acute bout.29 Colchicine has been used in patients with

erythema nodosum and coexisting Behçet's syndrome, with varying

results.30