red lumps on leg

[Pollyanna]

Hi all,
I developed some red patches of sore, raised spots on my right leg last week. It was very bright red, livid actually, and tender. Not wanting to be an alarmist, I gave it a couple of days to see if it would right itself. Not. So I made the calls yesterday and couldn't get in to see neither my internist nor my rheumy, but the rheumy nurse said I needed to be seen by someone.

Went to the local emergency care center and was seen. The rash was 5 days old and beginning to turn purple. The doc there said that is appeared to be erythema nodosum, but couldn't be sure. Okay. He did rule out a lot of other things which was good.

I've searched this site as well as the web, and it doesn't appear to be that common. Can anyone share their experience with me? I asked the doc outright if it was vasculitis and he said no. I'm just curious of what to look forward to, or if this might mean I'm in a flare?? It hasn't appeared to spread at all, and only the one leg is affected. It's still purple, but fading slightly, and still tender. Also, is this the same thing as lupus profundus?

Any input would be appreciated. I guess that I'm so afraid of losing my mind like I did before (with seizures, severe brain fog and cognitive breakdown) that I'm ever aware of what's going on with my body now. I decided I like having my wits about me! Thanks and God bless! :love:
Pollyanna

[CTuit]

There are a couple of good sites on the web that describe erythema nodosum. I've had it myself, it was actually the first sign I had that anything was wrong. Red, painful knots on my legs and a couple near my wrists. Some of them seemed to take forever to go away and I continued to get them for several weeks. I've included a bit from one of the articles:


Erythema nodosum is a type of skin inflammation that is located in a certain portion of the fatty layer of skin. Erythema nodosum results in reddish, painful, tender lumps most commonly located in the front of the legs below the knees. The tender lumps, or nodules, of erythema nodosum range in size from 1 to 5 centimeters. The nodular swelling is caused by a special pattern of inflammation in the fatty layer of skin.

Erythema nodosum can be self-limited and go away on its own in 3 to 6 weeks. Upon resolution, it can go away with only temporary bruised appearance or leave a chronic indentation change in the skin where the fatty layer has been injured.

There are several scenarios for the outcome of erythema nodosum. Typically, these areas of nodular tenderness range in size from about a dime to a quarter and they may be tender and inflamed off and on for a period of weeks. They usually then resolve spontaneously, each one of the little areas of inflammation by shrinking down and then becoming flat rather than raised and inflamed. They leave a bruised appearance. Then, they resolve spontaneously completely. Other lesions can sometimes pop up elsewhere. This may occur for periods of weeks to months and then eventually goes away. However, chronic erythema nodosum that may last for years is another pattern. Chronic erythema nodosum, with intermittent recurrences, can occur with or without an underlying disease present.

[Clare.T]

I think a biopsy would have to be done to distinguish from lupus profundus aka panniculitis which also affects the panniculus or whatever that layer of fat is called also from other forms of panniculitis.

A health history should be taken to see what might be causing the EN, if it is that.

http://www.emedicine.com/derm/topic138.htm

http://www.dermnetnz.org/index.html

I hope it clears up soon

Clare

[Pollyanna]

Thank you both for the information. I'm going to do some more reading!
:love: Pollyanna

[frono]

Hi Pollyana,

Just thought I would tell you my story about Erythema Nodosum. My neighbor told my they were spider bites (eeewwwww) so I let them go and a month later things got worse and they we're on both legs, my ankles swelled, I couldn't walk in the morning, it was awful. Don't laugh, I thought I must have had some spider infestation in my house and they came out to get me while I was sleeping (haha). I finally went to the doc who knew what it was but unsure how to treat it, so off to dermy I go and get a biopsy. Yep, it turned out to be Erythema Nodosum, back on pred I go, helps but they don't go away. Finally, after NINE loooooooooooong months and lots of pred they start going away. I had a lump on my left knee and my knee still gives me problems and it's been a year. You are right, it is extremley rare, my rhuemy, dermy and gp have never actually had a patient with it, they had only heard of it. I guess that makes us special (hehe). No thanks, I don't think I want to be special ever again. They were so painful I would cry after I got off work. Please let us know what you find out, do go get a biopsy to be sure, if you can.

Lot's of Love and Luck

[Pollyanna]

Tiercy,
Thank you for your reply ~ It really helps to compare stories! I thought it was weird the way the doc lowered his voice the way he did. I mean, he said, "I didn't want to bring it up, but, <and here he lowered his voice> I think it could be erythema nodosum." Then his voice went back to normal. The way he acted, maybe he was unsure of his dx, but I thought maybe I had something that was socially unacceptable! :oops: And me married 20 years to the same fella, dh was going to have some explaining to do! :lol:

Seriously, I wonder now if it was that after all. It's been 8 days now, and even tho' there is still a small tender lump, the color has gone from bright red, to purple/red, to purple, to pale violet and now there are just a few dark pink spots left. There is one larger bruised looking place, that is indented. It seems from what I've read online and from this site (and even from your experience) that EN hangs around lots longer.

At this point, to get it biopsied would probably be hard as I read that punch biopsies don't work, and since the swelling is down so much, it might be hard to go deep. In any case, I'm calling the rheumy today to update her and see what she wants me to do.

Oh, I forgot, the emergency doc put me on 1500 mg Keflex "just in case" it was an infection of some sort. So now I'm wondering if it was and/or the reason it's resolving so quickly is because of the bigtime antibiotic treatment? :shrug: Who knows!

Thanks again to everyone for answering me. :flowers: If I find out anything new, I'll update this post. And frono, I thought spiders had invaded my bed too! Yuck! :sick:

Stay well, Pollyanna :love:

[sandybear]

Insist on a biopsy....I had bright red/purple patches on my lower legs after flying. First doctor dismissed it as nothing major. Happened three more times (always after flying) and only on the fourth time and seeing a dermatologist did I get a biopsy. Even the dermo was surprised when the results came back as vasculitis but at least now I know what it is and how to treat it.

[Pollyanna]

SandyBear,

How did you treat this?

I searched this site and found the first time my right leg broke out was this time in 2004. It's done it at least two times since then and was diagnosed as vasculitis and cellulitis.

I'm curious what they treated you with. :?

Thanks! Pollyanna