Erythema nodosum
Erythema nodosum is inflammation of the fatty tissue under the skin, producing firm, painful red lumps on the shins.
Prescription review online
A doctor will review your case and issue a prescription if medically appropriate.
Talk to a doctor online
Discuss your symptoms and possible next steps with a doctor online.
On this page
Medicines commonly prescribed for Erythema nodosum
For informational purposes only. Always consult a doctor before using any medicine.
Dosage form: ORAL SOLUTION/SUSPENSION, 40 mg/mlActive substance: ibuprofenManufacturer: Ferrer Internacional S.A.Prescription not requiredDosage form: TABLET, 200 mgActive substance: ibuprofenManufacturer: Farmalider S.A.Prescription not requiredDosage form: TABLET, 600 mgActive substance: ibuprofenManufacturer: Viatris Pharmaceuticals S.L.U.Prescription required
Erythema nodosum is inflammation of the fatty tissue under the skin, producing firm, painful red lumps on the shins. In itself it is not dangerous and settles within a few weeks. What matters is something else: it is the body reacting to something else, and the doctor's job is to find what triggered it. Sometimes the cause is harmless; sometimes it needs treatment in its own right.
How it looks
- firm, painful lumps 1–5 cm across, raised above the skin, with indistinct edges;
- the colour is bright red at first, then purple, then bluish and finally yellow-green — like a resolving bruise;
- almost always symmetrical, on the front of the shins; less often on thighs, forearms and trunk;
- painful to touch and sometimes spontaneously; the overlying skin is warm;
- they never open or discharge pus — an important distinction from other conditions of the subcutaneous tissue;
- there is often swelling of the lower legs and joint discomfort, especially in the ankles and knees;
- it frequently begins with general malaise: fever, aching and weakness one to two weeks before the lumps appear;
- no scarring results; pigmentation over the sites persists for months.
Causes
In about a third of cases no cause is found, and that is a normal outcome. The most common known causes are:
- infections — a preceding streptococcal throat infection, the commonest cause in adults; gut infections, tuberculosis, fungal infections and, in some regions, specific local organisms;
- medicines — combined oral contraceptives, sulfonamides, some antibiotics;
- pregnancy;
- sarcoidosis — the combination of erythema nodosum, joint pain, fever and enlarged chest lymph nodes has its own name and usually runs a benign course;
- inflammatory bowel disease — Crohn's disease and ulcerative colitis;
- less often — other autoimmune conditions, lymphoma and other cancers.
When to see a doctor
It is worth attending in any case — not for the lumps themselves, but to find the cause.
- painful, firm red lumps have appeared on the shins;
- they come with fever, cough or breathlessness;
- there is diarrhoea, blood in the stool, abdominal pain or weight loss;
- joints are painful and swollen;
- the lumps appeared after starting a new medicine;
- the rash lasts longer than 6–8 weeks or keeps recurring;
- a lump has opened or is discharging pus — that is a different situation and needs examination;
- you had a severe sore throat beforehand.
How it is investigated
The diagnosis is made from the appearance and distribution — biopsy is rarely needed, only for an atypical picture. The main work goes into finding the cause:
- full blood count and inflammatory markers;
- throat swab and antistreptolysin O titre;
- chest X-ray — to avoid missing sarcoidosis and tuberculosis; one of the key investigations;
- a tuberculosis test;
- markers of bowel inflammation if there are gut symptoms;
- a pregnancy test;
- a review of the full list of medicines.
Treatment
The main thing is to treat the cause; the erythema itself resolves. For symptom relief:
- rest and elevation of the legs — this works better than it sounds, because the lumps hurt more the longer you stand;
- non-steroidal anti-inflammatory drugs for pain and inflammation; used with caution in inflammatory bowel disease;
- compression stockings — reduce swelling and soreness;
- cool compresses;
- potassium iodide for persistent cases;
- corticosteroids — only after infection, particularly tuberculosis, has been excluded;
- withdrawal of the responsible medicine, decided by a doctor;
- antibiotics if streptococcal infection is confirmed.
How long it lasts
An individual lump resolves in one to two weeks and the whole episode usually in three to six. Pigmentation over the sites persists for up to several months. In around one in five people the condition returns — more often when the cause was never identified or is still present.
Common questions
Is it contagious? No. The infection that triggered it may be, but the lumps are not.
Can I go to work? Yes, if the work does not involve long periods standing. Elevate your legs whenever you can.
Is a biopsy needed? Usually not — the picture is fairly characteristic.
Why a chest X-ray when my legs hurt? To check for sarcoidosis and tuberculosis — common causes that would not otherwise be seen.
Will it scar? No. Only dark patches remain, and they fade gradually.
Online consultation
In an online consultation the doctor reviews photographs and the distribution of the lumps, goes through the past few weeks with you — infections, new medicines, bowel and joint symptoms — draws up the list of tests and X-rays needed, and explains how to reduce the soreness while the cause is being established.
This material is for information only and does not replace a medical consultation.
Consult with a doctor about Erythema nodosum
Discuss your symptoms and possible next steps with a doctor online.
Medically reviewed by
Reviewed on Jul 5, 2026
Online doctors for Erythema nodosum
Discuss your symptoms and possible next steps for Erythema nodosum with a doctor online.
