Erythema nodosum: nodules on the legs

Erythema nodosum is a panniculitis usually presenting as tender nodules on the shins. It names a syndrome rather than its cause.

Inspect both legs, then palpate the lesions for elevation, warmth, tenderness and consistency. Establish onset and changes in colour.

The photograph shows several rounded erythematous areas of different sizes on both legs. Ink circles are landmarks added by the source.

History should explore recent infection, medication, bowel symptoms and sarcoidosis. Investigations depend on associated findings and local epidemiology, including tuberculosis.

Superficial thrombophlebitis, skin infection and other panniculitides may cause painful lesions. Ulceration or an atypical location should prompt reconsideration.

Assess fever, ankle arthralgia, cough and diarrhoea. A photograph of the legs cannot establish Löfgren syndrome.

Marked systemic illness, disproportionate pain or rapid progression require prompt assessment, particularly to exclude a deep infection.

Redness alone proves neither panniculitis nor its cause. Warmth, pain and subcutaneous depth cannot be assessed from this image.

First describe location and distribution; confirm nodules by palpation before directing the investigation of their cause.

• DermNet — Erythema nodosum ↗
• James Heilman, MD — document iconographique original / original image ↗

Documentary review: 2026-10-16