What are the other Names for this Condition? (Also known as/Synonyms)

• Erythema Nodosum due to IBD
• IBD-Associated Erythema Nodosum
• Inflammatory Bowel Disease-Associated Erythema Nodosum

What is Erythema Nodosum due to Inflammatory Bowel Disease? (Definition/Background Information)

• Erythema nodosum is a skin condition that causes painful red subcutaneous nodules. It may be caused by numerous factors including certain medications, infectious diseases, pregnancy, blood cancer, and many other disorders
• Erythema Nodosum due to Inflammatory Bowel Disease occurs against a background of inflammatory bowel disease (IBD), a chronic condition that involves the gastrointestinal tract. The two most prominent IBDs include Crohn’s disease and ulcerative colitis
• Currently, the exact cause of development of inflammatory bowel disease is unknown. It is a chronic long-standing illness involving the digestive system that is associated with frequent flare-ups and symptom-free periods (remission)
• The nodules in Erythema Nodosum due to Inflammatory Bowel Disease may occur on the legs and the arms. The signs and symptoms of IBD may include abdominal pain, mouth ulcers, blood in stool, anemia, rashes on the skin, and joint pain
• Adequate treatment of the underlying condition can help resolve Erythema Nodosum due to Inflammatory Bowel Disease. With appropriate treatment of inflammatory bowel disease, the prognosis for erythema nodosum is good in a majority of individuals

Who gets Erythema Nodosum due to Inflammatory Bowel Disease? (Age and Sex Distribution)

• Erythema Nodosum due to Inflammatory Bowel Disease may occur at any age. It is seen in both children and adults
• Both males and females are affected
• It can affect individuals of any ethnicity, race or region. Some ethnicities and geographical regions show a higher incidence of inflammatory bowel disorders

What are the Risk Factors for Erythema Nodosum due to Inflammatory Bowel Disease? (Predisposing Factors)

• Individuals with inflammatory bowel diseases, such as Crohn’s disease and ulcerative colitis, are at an increased risk for developing Inflammatory Bowel Disease-Associated Erythema Nodosum

It is important to note that having a risk factor does not mean that one will get the condition. A risk factor increases one’s chances of getting a condition compared to an individual without the risk factors. Some risk factors are more important than others.

Also, not having a risk factor does not mean that an individual will not get the condition. It is always important to discuss the effect of risk factors with your healthcare provider.

What are the Causes of Erythema Nodosum due to Inflammatory Bowel Disease? (Etiology)

• Research scientists believe that Erythema Nodosum due to Inflammatory Bowel Disease is caused by an immunological response of the body to inflammatory bowel disease. The nodules form on skin as a reaction to the underlying condition
• Currently, no definitive causes are identified for inflammatory bowel disease (IBD). It is reported that the condition may be caused by a variety of factors such as immune-related factors, genetic factors, and environmental factors

What are the Signs and Symptoms of Erythema Nodosum due to Inflammatory Bowel Disease?

The signs and symptoms of Erythema Nodosum due to Inflammatory Bowel Disease may include:

• Presence of nodules beneath the skin
• They begin as flat, firm, dark red lesions. The size varies from 5 mm to about 4 cm 
• After a few days, the lesions become elevated and turn purple. Weeks later, they become flat brownish patches
• The nodules may be present on any part of the body, especially on the legs, thighs, buttocks, and forearms. The ankles and lower shins are the most frequent locations involved
• The signs and symptoms of underlying inflammatory bowel disease may include diarrhea, mouth sores, abdominal pain, rectal bleeding and anemia, fatigue, weight loss, and joint pain

How is Erythema Nodosum due to Inflammatory Bowel Disease Diagnosed?

The following procedures may be used to diagnose Erythema Nodosum due to Inflammatory Bowel Disease:

• Thorough evaluation of the individual’s medical history and a complete physical examination
• Assessment of the presenting signs and symptoms
• Various blood tests to diagnose inflammatory bowel disease such as complete blood count, metabolic panel tests, erythrocyte sedimentation rate, and serum C-reactive protein test
• Stool examination
• Upper GI and lower GI series studies
• Colonoscopy and sigmoidoscopy
• Imaging studies that include CT and MRI scans to visualize the abdomen region
• Tissue biopsy, if necessary: A skin/tissue biopsy is performed and sent to a laboratory for a pathological examination. The pathologist examines the biopsy under a microscope. After putting together clinical findings, special studies on tissues (if needed) and with microscope findings, the pathologist arrives at a definitive diagnosis

Many clinical conditions may have similar signs and symptoms. Your healthcare provider may perform additional tests to rule out other clinical conditions to arrive at a definitive diagnosis.

What are the possible Complications of Erythema Nodosum due to Inflammatory Bowel Disease?

• Major complications associated with skin lesions of Erythema Nodosum due to Inflammatory Bowel Disease are not reported
• However, complications are mainly observed due to the underlying Crohn’s disease or ulcerative colitis. Severe disease can lead to arthritis, ulceration of skin, internal GI bleeding, stricture formation, perforation of the bowel, malnutrition, and even colorectal cancer

How is Erythema Nodosum due to Inflammatory Bowel Disease Treated?

The treatment options of Erythema Nodosum due to Inflammatory Bowel Disease include treating the underlying IBDs, or Crohn’s disease and ulcerative colitis, which is undertaken through:

• Modification of lifestyle that includes well-balanced and dietician-approved diet, exercising, and avoiding factors that may aggravate the condition
• Effective management of stress
• Nutritional supplementation
• Administration of medications for the symptoms
• Surgery to remove part or all of the large intestine (colon), if necessary
• Symptomatic and supportive therapy
• Systemic steroids or steroid-containing enemas
• Immunosuppressive therapy via methotrexate, azathioprine, 6-mercaptopurine, and others
• Targeted biologic therapy including TNF alpha inhibitors, interleukin 12/23 inhibitors, and others

 Presently, there is no cure for inflammatory bowel diseases.

The erythema nodosum (EN) component triggered by inflammatory bowel disease can be controlled more rapidly by adding the following treatments specific to EN

• Systemic corticosteroids
• NSAIDs such as ibuprofen
• Iodine, used as a medication

How can Erythema Nodosum due to Inflammatory Bowel Disease be Prevented?

The prevention of Erythema Nodosum due to Inflammatory Bowel Disease is linked to preventing the associated inflammatory bowel disease. Currently, there are no definitive measures available to prevent the condition. However, the following steps are suggested:

• Undertaking early diagnosis and treatment of Crohn’s disease and ulcerative colitis
• Having an active and healthy lifestyle with balanced diet
• Smoking cessation
• Limiting alcohol consumption

What is the Prognosis of Erythema Nodosum due to Inflammatory Bowel Disease? (Outcomes/Resolutions)

• The prognosis for Erythema Nodosum due to Inflammatory Bowel Disease is usually good with adequate treatment of inflammatory bowel disease (IBD)
• The skin nodules often get better when the underlying IBD responds to treatment measures
• Even though erythema nodosum is a benign skin condition, the overall prognosis is dependent on the underlying IBD and the severity of the symptoms presented

Additional and Relevant Useful Information for Erythema Nodosum due to Inflammatory Bowel Disease:

• Cleaning the skin too hard with strong chemicals or soaps may aggravate the skin condition. Care must be taken avoid strong soaps and chemicals that could potentially worsen the condition
• The presence of dirt on the body is not a causative factor for the condition. However, it helps to be clean and hygienic, which may help the condition from getting worse