Medication Summary
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.[15] 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.[16]
Anti-inflammatory agents
Class Summary
Provide symptomatic relief for lesional tenderness, arthralgia, and fever.
Aspirin (Anacin, Ascriptin, Bayer Aspirin)
Salicylate used for anti-inflammatory, analgesic, and antipyretic properties. Treats mild-to-moderate pain and headache. Inhibits prostaglandin synthesis, which prevents formation of platelet-aggregating thromboxane A2. Acts on heat-regulating center of hypothalamus, and vasodilates peripheral vessels to reduce fever. Enteric-coated and extended-release tabs are available.
Naproxen (Naprelan, Naprosyn, Aleve, Anaprox)
Has analgesic, anti-inflammatory, and antipyretic properties. Inhibits inflammatory reactions and pain by decreasing activity of cyclo-oxygenase, which is responsible for prostaglandin synthesis.
Indomethacin (Indocin, Indochron E-R)
Rapidly absorbed; metabolism occurs in liver by demethylation, deacetylation, and glucuronide conjugation; inhibits prostaglandin synthesis.
Colchicine
Reduces formation of uric acid crystals in affected joint, thereby reducing amount of acute inflammation and pain; also decreases uric acid levels in blood.
Can be used in combination with probenecid on a chronic basis to prevent gout or can be used alone to treat pain and inflammation of acute gout attacks. Discontinue when pain of gout attack begins to subside, when maximum dose is reached, or when GI tract symptoms (eg, nausea, vomiting, diarrhea) indicate cellular poisoning.
Antithyroid agents
Class Summary
Relieve lesional tenderness, arthralgia, and fever. Relief may occur within 24 h. Most lesions completely subside within 10-14 d. 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.
Potassium iodide (Pima, SSKI)
Mechanism of action in erythema nodosum is unknown, but potassium iodide is known to enhance response by potentiating neutrophil activity.
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