Medical Care

Although erythema induratum (nodular vasculitis) is not a life-threatening condition, treatment is usually administered because it can cause significant pain and disfigurement in affected individuals; untreated underlying illnesses such as tuberculosis (TB) can also cause significant morbidity or death if left untreated. TB-associated erythema induratum generally responds well to multidrug anti-TB therapy.^[3]

In other cases, nonsteroidal anti-inflammatory drugs (NSAIDs), bed rest, leg elevation, compression stockings, tetracyclines, and potassium iodide have proven effective.^[3]Potassium iodide, while effective, requires caution when used in children or in patients with thyroid disease.^{[4, 31]}

If underlying disease cannot be identified and treated, management of erythema induratum can be challenging. In cases of idiopathic erythema induratum or erythema induratum in which the underlying disease cannot be treated or cured, oral potassium iodide is the preferred treatment and may lead to remission.^[47]In one study of patients with non–TB-associated erythema induratum, 16 of 17 patients responded to oral potassium iodide (360-900 mg/day), with pain and swelling decreasing after 2 days and complete resolution after 4 weeks of treatment.^[48]Treatment with potassium iodide is well tolerated, and recurrences respond well to re-treatment. Long-term treatment with potassium iodide is associated with a risk of hypothyroidism. Other possible adverse effects include gastrointestinal symptoms, salivary gland enlargement, and potassium toxicity.^[49]Other therapeutic options for non–TB-associated erythema induratum have been suggested, but evidence for their benefit is limited to case reports. Among these options are systemic glucocorticoids (once infection has been ruled out), dapsone, clofazimine, colchicine, gold salts, mycophenolate mofetil, and topical TB therapy.^{[3, 28, 50, 51, 52, 53]}

Medication

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Media Gallery

This patient exhibited tender, erythematous nodules confined to the lower third of the legs.
Vasculitis and granulomatous inflammation in the dermis and subcutaneous fat tissues.
Evidence of panniculitis exhibiting lobular, granulomatous, and lymphohistiocytic inflammation.
A positive Mantoux test reaction in a patient with erythema induratum.

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Author

Esther A Balogh, MD Research Fellow, Center for Dermatology Research, Department of Dermatology, Wake Forest University School of Medicine

Disclosure: Nothing to disclose.

Coauthor(s)

William W Huang, MD, MPH, FAAD Associate Professor and Residency Program Director, Department of Dermatology, Wake Forest Baptist Health, Wake Forest University School of Medicine

William W Huang, MD, MPH, FAAD is a member of the following medical societies: American Academy of Dermatology, Association of Professors of Dermatology, Dermatology Foundation, Medical Dermatology Society, North Carolina Medical Society, Women's Dermatologic Society

Disclosure: Research PI for Sponsored Trial for: Gilead; Genentech;.

Specialty Editor Board

Richard P Vinson, MD Assistant Clinical Professor, Department of Dermatology, Texas Tech University Health Sciences Center, Paul L Foster School of Medicine; Consulting Staff, Mountain View Dermatology, PA

Richard P Vinson, MD is a member of the following medical societies: American Academy of Dermatology, Texas Medical Association, Association of Military Dermatologists, Texas Dermatological Society

Disclosure: Nothing to disclose.

Lester F Libow, MD Dermatopathologist, South Texas Dermatopathology Laboratory

Lester F Libow, MD is a member of the following medical societies: American Academy of Dermatology, American Society of Dermatopathology, Texas Medical Association

Disclosure: Nothing to disclose.

Chief Editor

William D James, MD Paul R Gross Professor of Dermatology, Vice-Chairman, Residency Program Director, Department of Dermatology, University of Pennsylvania School of Medicine

William D James, MD is a member of the following medical societies: American Academy of Dermatology, Society for Investigative Dermatology

Disclosure: Received income in an amount equal to or greater than $250 from: Elsevier; WebMD<br/>Served as a speaker for various universities, dermatology societies, and dermatology departments.

Additional Contributors

Jean-Hilaire Saurat, MD Chair, Professor, Department of Dermatology, University of Geneva, Switzerland

Jean-Hilaire Saurat, MD is a member of the following medical societies: American Academy of Dermatology, Society for Investigative Dermatology

Disclosure: Nothing to disclose.

Noah S Scheinfeld, JD, MD, FAAD † Assistant Clinical Professor, Department of Dermatology, Weil Cornell Medical College; Consulting Staff, Department of Dermatology, St Luke's Roosevelt Hospital Center, Beth Israel Medical Center, New York Eye and Ear Infirmary; Assistant Attending Dermatologist, New York Presbyterian Hospital; Assistant Attending Dermatologist, Lenox Hill Hospital, North Shore-LIJ Health System; Private Practice

Noah S Scheinfeld, JD, MD, FAAD is a member of the following medical societies: American Academy of Dermatology

Disclosure: Nothing to disclose.

Acknowledgements

The authors and editors of Medscape Reference gratefully acknowledge the contributions of previous previous authors, Beom Joon Kim, MD, and Kwang-Hyun Cho, MD, to the development and writing of this article.