Erythema Induratum (Nodular Vasculitis) Medication

Updated: Nov 15, 2019
  • Author: Esther A Balogh, MD; Chief Editor: William D James, MD  more...
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Medication

Medication Summary

When treating erythema induratum (nodular vasculitis), combination therapy with isoniazid, ethambutol, and rifampicin should be continued for 9 months. [31] Erythema induratum should begin to respond to therapy by 6 weeks. [2] In addition, antipyretics and analgesics usually are required for symptomatic relief. After antituberculotic treatment for tuberculosis (TB), treatment for erythema induratum mirrors that of erythema nodosum (eg, naproxen, potassium iodide). [31]

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Antitubercular Agents

Class Summary

Anti-TB agents are used for empiric coverage of M tuberculosis.

Isoniazid (Nydrazid, Laniazid)

Isoniazid is the best combination of effectiveness, low cost, and minor adverse effects. It is a first-line drug unless resistance or another contraindication is known. Therapeutic regimens of less than 6 months demonstrate an unacceptably high relapse rate. Coadministration of pyridoxine is recommended if peripheral neuropathies secondary to isoniazid therapy develop. Prophylactic doses of 6-50 mg of pyridoxine daily are recommended. Isoniazid is available as a syrup (50 mg/5 mL) and tablet (100 or 300 mg).

Rifampin (Rifadin, Rimactane)

Rifampin is for use in combination with at least one other antituberculous drug; it inhibits DNA-dependent bacterial but not mammalian RNA polymerase. Cross-resistance may occur. Treat for 6-9 months or until 6 months have elapsed from conversion to sputum culture negativity. Rifampin is available as a capsule (150 mg or 300 mg) and powder for injection (600 mg).

Ethambutol (Myambutol)

Ethambutol diffuses into actively growing mycobacterial cells, such as tubercle bacilli. It impairs cell metabolism by inhibiting the synthesis of 1 or more metabolites, which, in turn, causes cell death. No cross-resistance is demonstrated.

Mycobacterial resistance is frequent with previous therapy. In these patients, use in combination with second-line drugs not previously administered. Administer every 24 hours until permanent bacteriologic conversion and maximal clinical improvement is seen. Absorption is not significantly altered by food. Ethambutol is available as 100- and 400-mg tablets.

Pyrazinamide

Pyrazinamide is a pyrazine analog of nicotinamide that may be bacteriostatic or bactericidal against M tuberculosis, depending on the concentration of drug attained at the site of infection; its mechanism of action is unknown. Administer for initial 2 months of a 6-month or longer treatment regimen for patients who are susceptible to the drug. Treat patients who are resistant to the drug with individualized regimens. Pyrazinamide is available as a 500-mg scored tablet.

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Antithyroid agents

Class Summary

These agents relieve lesional tenderness, arthralgia, and fever. Relief may occur in 24 hours. Most lesions completely subside within 10-14 days.

Potassium iodide (Thyro-Block, SSKI, Pima)

Potassium iodide's mechanism of action is unknown, but it is known to enhance response by potentiating neutrophil activity. It is not effective for all patients with erythema induratum. Patients who receive medication shortly after the initial onset of induratum respond more satisfactorily than those with chronic induratum.

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NSAIDs

Class Summary

NSAIDs can be used for symptomatic pain relief and in cases of non–TB-associated erythema induratum.

Ibuprofen (Advil, Motrin, PediaCare Children's Pain Reliever/Fever Reducer IB)

Ibuprofen inhibits the synthesis of prostaglandins in body tissues by inhibiting at least two cyclooxygenase (COX) isoenzymes, COX-1 and COX-2. It may inhibit chemotaxis, alter lymphocyte activity, decrease proinflammatory cytokine activity, and inhibit neutrophil aggregation; these effects may contribute to anti-inflammatory activity.

Naproxen (Aleve, Anaprox, Anaprox DS)

Naproxen inhibits the synthesis of prostaglandins in body tissues by inhibiting at least two cyclooxygenase (COX) isoenzymes, COX-1 and COX-2. It may inhibit chemotaxis, alter lymphocyte activity, decrease proinflammatory cytokine activity, and inhibit neutrophil aggregation; these effects may contribute to anti-inflammatory activity.

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