# Erythema nodosum - Category: chronic - Review status: reviewed (every claim checked against a document named on this page) - Sources: Naproxen 500 mg Tablets SmPC section 4.2 (eMC product 2639) · No dose - assessment step, no medicine given - Verified date: 2026-08 ## Verified against - Naproxen 500 mg Tablets SmPC section 4.2 (eMC product 2639) - No dose - assessment step, no medicine given - Erythema nodosum - disease-level clinical article (erythema-nodosum-clinical.txt) ## Treatment metadata - No drug therapy in primary care (Assess first) - Naproxen — 500 mg — oral.solid - Colchicine — oral.solid ## Complete treatment card ```text ERYTHEMA NODOSUM Sources: Naproxen 500 mg Tablets SmPC section 4.2 (eMC product 2639) · No dose - assessment step, no medicine given Review status: REVIEWED against Naproxen 500 mg Tablets SmPC section 4.2 (eMC product 2639), No dose - assessment step, no medicine given, Erythema nodosum - disease- level clinical article (erythema-nodosum-clinical.txt) (2026-08) IS IT THIS? - reference only, to read alongside your own examination SYMPTOMS - what the patient reports (4) - An early phase brings fever, joint pain, and sometimes belly pain [abdominal pain · fever · joint pain] - A handful of small, roughly symmetric bumps appear on both sides and hurt on their own - Standing makes the pain worse, so patients naturally prefer lying down with the legs elevated - More than half of patients also report joint and muscle aches, sometimes with morning stiffness and swelling [joint stiffness · muscle pain] SIGNS - what you find (7) - Firm bumps form on the extensor sides of the shins and knees, occasionally the thighs or forearms - On palpation the nodules measure 10 to 40 mm, feel warm and firm, and move freely over deeper tissue - Swelling around the ankles is a common accompanying finding - Enlarged hilar lymph nodes can occur and be mistaken for sarcoidosis - Individual nodules fade over about ten days, passing through bruise-like blue and yellow colors before clearing [bruising] - Unlike some other panniculitides, these nodules never break down, ulcerate, or scar [scarring] - Joint fluid, when sampled, is sterile and there is no destructive joint damage TESTS (6) - A blood count and CRP are checked when an infectious trigger is suspected - A TB skin test, chest x-ray, and interferon-gamma assay are ordered if tuberculosis or Lofgren syndrome is suspected - A throat swab, culture, and streptococcal antibody titers are checked if strep is a suspected trigger - Paired viral serology taken four weeks apart can confirm a viral trigger - Stool studies are sent when diarrhea or other digestive symptoms are present - A skin biopsy is reserved for atypical or uncertain presentations IF NOT THIS - what else fits (2) - Vasculitic panniculitis affecting deeper vessels can make the nodules necrotic, unlike erythema nodosum, and needs biopsy to confirm - Lobular panniculitis produces greasy lesions that, unlike erythema nodosum, can liquefy, fistulate, and scar, and requires biopsy to diagnose Source StatPearls "Erythema Nodosum" - disease-level clinical article Status traced to the source above 1. NO DRUG THERAPY IN PRIMARY CARE (ASSESS FIRST) [1st line] Adult Erythema nodosum is a reaction pattern, not a diagnosis. The lumps settle by themselves over weeks; the work is finding what set them off. In Egypt, exclude tuberculosis actively - chest x-ray and a tuberculin or interferon-gamma test. Then look for streptococcal throat infection (ASO titre), sarcoidosis (the same chest x-ray), inflammatory bowel disease, pregnancy, and drugs, especially the combined pill and sulfonamides. - Assess, then decide Peds In a child, erythema nodosum is most often post-streptococcal. Take a throat swab and an ASO titre, and still do the chest x-ray. Source No dose - assessment step, no medicine given Why Treating the pain without looking for the cause is how a first presentation of tuberculosis, sarcoidosis or Crohn's disease gets missed. The skin has done the diagnostic work; the job is to follow it. Caution Bed rest and leg elevation genuinely help, and compression stockings help the aching once the acute tenderness has settled. Ulcerating lesions, lesions that scar, or lumps still present after 8 weeks are not straightforward erythema nodosum - biopsy and refer. Systemic corticosteroids should not be started until infection, and tuberculosis in particular, has been excluded. 2. NAPROXEN [1st line] Adult 500 mg twice daily with food - Until the nodules settle, usually 2-6 weeks; review rather than continue indefinitely Peds Not recommended for use in any other indication in children under 16 years of age. Source Naproxen 500 mg Tablets SmPC section 4.2 (eMC product 2639) Why An NSAID controls the pain in the lumps and the accompanying joint aching while the reaction burns itself out. It is symptomatic treatment - the condition resolves on its own. Caution The naproxen label does not list erythema nodosum by name. The dose here is the standard adult naproxen dose from that label; using it for erythema nodosum is accepted practice rather than a licensed indication. Do not give an NSAID with active peptic ulcer disease, significant renal impairment, heart failure, or in the third trimester of pregnancy - and erythema nodosum is itself common in pregnancy. Take it with food, and consider gastric protection in anyone over 65 or on an antiplatelet. A topical corticosteroid is deliberately not offered. The inflammation is in the subcutaneous fat, far below anything a cream reaches. Egypt ORGOPROXEN 500 MG 20 TAB. ORGANOPHARMA ... 16.00 EGP (0.80/unit) NAPROSYN 500 MG 10 TAB. MISR > F.HOFF... 8.05 EGP (0.81/unit) NAPROFEN 500MG 10 TAB. EL NILE. 12.00 EGP (1.20/unit) NAPROFEN 500MG 20 TAB. EL NILE. 24.00 EGP (1.20/unit) 3. COLCHICINE [add-on - not a substitute] Adult 1 to 2 mg/day - until symptoms improve Peds No paediatric dose is stated in the sources held for this drug. Source Erythema nodosum - disease-level clinical article (erythema-nodosum-clinical.txt) Why Second-line anti-inflammatory option for persistent or symptomatic erythema nodosum. Caution GIVE IT WITH THE ANTI-INFLAMMATORY, NOT INSTEAD OF IT. Egypt COLCHICINE 500 MCG 100 TABS. EL NASR 190.00 EGP (1.90/unit) COLMEDITEN 0.5 MG 100 TABS. KAHIRA 190.00 EGP (1.90/unit) GOURYST 0.5 MG 100 TABS. PHAROPHARMA 190.00 EGP (1.90/unit) COLCHIOPO 0.6 MG 30 F.C. TABS. BORG PHARMACE... 61.50 EGP (2.05/unit) COLCHIOPO 1 MG 20 F.C. TABS. BORG PHARMACE... 61.00 EGP (3.05/unit) Prices are indicative (dataset snapshot 2026-06); verify with the pharmacy. ``` --- Dawaa Reference is a reference for prescribers, not a medical device, and does not replace clinical judgement. [Privacy policy](/privacy)