Erythema Nodosum Medication
- Author: Jeanette L Hebel, MD; Chief Editor: William D James, MD more...
If the underlying disease or drug is identified, it should be eliminated. Since erythema nodosum often regresses spontaneously, symptomatic relief using NSAIDs (eg, acetyl salicylic acid, ibuprofen, naproxen, indomethacin) usually is all that is required. Corticosteroids are effective but seldom necessary in self-limited disease. Recurrence of erythema nodosum following discontinuation of treatment is common, and underlying infectious disease may be worsened. Potassium iodide may relieve lesional tenderness, arthralgia, and fever. Colchicine has been used in a few refractory cases with good results. Note that some of the medications used to treat erythema nodosum have been implicated as rare causes of erythema nodosum in individuals with hypersensitivity to the drugs.
Anti-inflammatory agents provide symptomatic relief for lesional tenderness, arthralgia, and fever.
Aspirin is a salicylate used for anti-inflammatory, analgesic, and antipyretic properties. It treats mild-to-moderate pain and headache. Aspirin inhibits prostaglandin synthesis, which prevents the formation of platelet-aggregating thromboxane A2. It acts on the heat-regulating center of the hypothalamus, and it vasodilates peripheral vessels to reduce fever. Enteric-coated and extended-release tablets are available.
Naproxen has analgesic, anti-inflammatory, and antipyretic properties. It inhibits inflammatory reactions and pain by decreasing the activity of cyclooxygenase, which is responsible for prostaglandin synthesis.
Indomethacin is rapidly absorbed; metabolism occurs in the liver by demethylation, deacetylation, and glucuronide conjugation; it inhibits prostaglandin synthesis.
Colchicine reduces the formation of uric acid crystals in affected joints, thereby reducing the amount of acute inflammation and pain; it also decreases uric acid levels in the blood.
Colchicine can be used in combination with probenecid on a long-term basis to prevent gout or it can be used alone to treat the pain and inflammation of acute gout attacks. Discontinue usage when the pain of a gout attack begins to subside, when the maximum dose is reached, or when GI tract symptoms (eg, nausea, vomiting, diarrhea) indicate cellular poisoning.
Antithyroid agents relieve lesional tenderness, arthralgia, and fever. Relief may occur within 24 hours. Most lesions completely subside within 10-14 days. Potassium iodide is not effective for all patients with erythema nodosum. Patients who receive medication shortly after the initial onset of erythema nodosum respond more satisfactorily than patients with chronic erythema nodosum.
The mechanism of action for potassium iodide in erythema nodosum is unknown, but it is known to enhance response by potentiating neutrophil activity.
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