Does erythema nodosum (EN) cause surface skin scaling or bleeding?

From the Guidelines

Erythema nodosum does not typically cause surface skin scaling or bleeding. This condition is characterized by raised, tender, red or violet subcutaneous nodules of 1–5 cm in diameter, commonly affecting the extensor surfaces of the extremities, particularly the anterior tibial areas 1. The histology reveals a non-specific focal panniculitis, and the prevalence of EN in IBD ranges from 4.2–7.5% 1. Some key features of erythema nodosum include:

• Tender, red or purple, raised nodules on the skin
• Most commonly appear on the shins, though they can occur elsewhere on the body
• Overlying skin remains intact without scaling, ulceration, or bleeding
• Nodules may be painful and warm to the touch
• Patients might experience accompanying symptoms like fever, fatigue, and joint pain
• Often a reaction to an underlying condition such as infection, medication, inflammatory bowel disease, or sarcoidosis The absence of scaling and bleeding is an important diagnostic feature of erythema nodosum, as these characteristics would suggest a different skin disorder 1. Treatment focuses on addressing the underlying cause while providing symptomatic relief with NSAIDs, rest, and elevation of the affected limbs, and in some cases, systemic steroids or immunomodulation with azathioprine, infliximab or adalimumab may be used 1.

From the Research

Erythema Nodosum Characteristics

• Erythema nodosum is characterized by tender, erythematous, subcutaneous nodules, usually located on the anterior aspects of the lower extremities 2, 3, 4, 5.
• The nodules are typically symmetrical, non-ulcerative, and resolve without permanent sequelae 2, 3, 4.
• The condition may be accompanied by fever, arthralgia, and other systemic symptoms 4.

Surface Skin Scaling or Bleeding

• There is no mention of surface skin scaling as a characteristic of erythema nodosum in the provided studies 2, 3, 4, 5, 6.
• Ulceration is explicitly stated as not being a feature of erythema nodosum 2, 3, 4, which implies that bleeding is not a typical characteristic of the condition.
• The studies suggest that erythema nodosum heals without atrophy or scarring 2, 3, 4, further indicating that surface skin scaling or bleeding is not a common aspect of the condition.

Treatment and Management

• Treatment of erythema nodosum is often directed at the underlying associated condition, if identified 2, 3, 5.
• Symptomatic care, nonsteroidal anti-inflammatory drugs, and other supportive measures may be used to manage the condition 2, 3, 4, 6.