Erythema Induratum (Nodular Vasculitis) Treatment & Management

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

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]