Erythema Nodosum in Grand Rapids, MI

Erythema nodosum is a skin condition that appears as red, tender lumps, most commonly on the shins or lower legs. In Grand Rapids and across West Michigan, this condition is seen more often in women than men (about three times more common) and usually develops between ages 20 and 45. It is uncommon in children under 15.

Because erythema nodosum can be linked to infections, medications, and autoimmune conditions, it’s important for residents in Grand Rapids to seek medical evaluation through local providers such as Spectrum Health, Trinity Health Grand Rapids, Metro Health, or Mercy Health if they notice these symptoms.

What Is Erythema Nodosum?

Erythema nodosum is an inflammatory condition of the fat layer under the skin (the subcutaneous tissue). It causes painful, red bumps (nodules) that are usually:

  • Located on the front of the shins or lower legs
  • Warm, firm, and very tender to the touch
  • Often appearing in clusters

The skin has three main layers:

  1. Epidermis – the outer protective layer
  2. Dermis – the middle layer containing blood vessels, nerves, and hair follicles
  3. Subcutaneous layer – the deepest layer, made mostly of fat, which provides support and cushioning

In erythema nodosum, immune cells collect in pockets within the subcutaneous layer, causing the characteristic lumps.

How Common Is Erythema Nodosum?

  • More common in women than men
  • Most often affects people 20–45 years old
  • Rare in children under 15 years

In a city like Grand Rapids, with a diverse adult population and several large hospital systems, erythema nodosum is typically diagnosed in primary care or dermatology clinics associated with Spectrum Health, Trinity Health Grand Rapids, Metro Health, and Mercy Health.

Symptoms of Erythema Nodosum

Main Skin Symptoms

The shins are most commonly affected, but other areas can also be involved.

Typical features include:

  • Raised, red, hot, and painful lumps on the skin
  • Lumps ranging from 1 cm to 20 cm wide
  • Up to 50 lumps may appear in the affected area
  • Most commonly on the:
    • Shins and lower legs
    • Ankles and calves
    • Thighs
    • Buttocks
    • Arms

Over time, the color of the lumps changes:

  • Start as bright red
  • Turn purple over a few days
  • Fade to brownish-yellow and flatten out over a few weeks
  • Often resemble a fading bruise as they heal

Even with treatment, the inflamed nodules can take 3 to 6 weeks to fully resolve.

Swelling and Joint Pain

Erythema nodosum can also cause:

  • Swelling of the legs, especially around the ankles
  • Joint pain, particularly in the knees and sometimes the ankles or other joints
  • General feelings of being unwell, such as:
    • Mild fever
    • Fatigue
    • Body aches

The lumps tend to recur or worsen if the person does not get enough rest. This is especially important during West Michigan’s colder months, when walking on icy sidewalks and standing for long periods can increase leg strain and discomfort.

Why Does Erythema Nodosum Happen?

An Immune System Reaction

Erythema nodosum is considered an immunological (immune system) response. It is not a contagious infection itself. Instead, it is often the body’s reaction to:

  • An infection
  • A medication
  • An underlying inflammatory or autoimmune disease

The characteristic lumps are caused by immune cells clustering in the subcutaneous fat layer. Sometimes the dermis (middle layer of the skin) can also be involved.

Common Triggers and Causes

In many cases, the exact trigger is never found. About 20% of cases have no clear cause.

Known or suspected triggers include:

Infections

  • Throat infections, usually bacterial (such as strep throat)
  • Tuberculosis (TB)
  • Sarcoidosis (often involving lymph nodes and lungs)
  • Hodgkin’s disease (a type of lymphoma)
  • Other infections, including:
    • Psittacosis (a bird-related infection)
    • Infectious mononucleosis (EBV or “mono”)
    • Hepatitis B
    • Syphilis

Medications and Hormonal Changes

  • Certain antibiotics, such as:
    • Penicillin
    • Sulphonamides
  • Bromides
  • Hormonal changes, including:
    • Pregnancy
    • Use of birth control pills or other hormone therapy

Other Medical Conditions

  • Inflammatory bowel disease (IBD), such as:
    • Crohn’s disease
    • Ulcerative colitis

In Grand Rapids, where respiratory infections are more common in the colder months and indoor crowding increases in winter, throat infections and other seasonal illnesses may occasionally act as triggers for erythema nodosum.

How Is Erythema Nodosum Diagnosed in Grand Rapids?

Because erythema nodosum can look similar to other skin conditions, such as vasculitis or necrobiosis lipoidica, careful diagnosis is important.

A healthcare provider in Grand Rapids—such as a primary care physician, dermatologist, or rheumatologist at Spectrum Health, Trinity Health Grand Rapids, Metro Health, or Mercy Health—may use the following steps:

Medical Evaluation

  • Detailed medical history
    • Recent infections (especially sore throats)
    • New medications or birth control
    • Recent travel
    • History of autoimmune or inflammatory diseases
  • Physical examination
    • Inspecting the skin lesions
    • Checking joints, lymph nodes, lungs, and abdomen

Diagnostic Tests

To identify or rule out underlying causes, your provider may order:

  • Biopsy of the subcutaneous tissue (a small sample of deep skin and fat)
  • Throat swab to check for strep or other bacterial infections
  • Blood tests, such as:
    • Inflammatory markers
    • Complete blood count
    • Tests for infections or autoimmune conditions
  • Chest X-ray, especially if sarcoidosis or tuberculosis is suspected
  • Specific tests for:
    • Tuberculosis (TB skin test or blood test)
    • Hepatitis B
    • Other suspected infections

Residents of Grand Rapids can access these tests through hospital systems like Spectrum Health and Trinity Health Grand Rapids, as well as independent imaging centers and labs in Kent County.

Treatment for Erythema Nodosum in Grand Rapids

Treatment depends on whether a specific cause is found. The goals are to:

  • Treat any underlying condition
  • Reduce pain, swelling, and inflammation
  • Support healing and prevent recurrence

Treating the Underlying Cause

If a cause is identified, treatment may include:

  • Antibiotics for bacterial throat infections
  • Changing or stopping a medication if it is suspected to be the trigger
  • Treating inflammatory bowel disease or other chronic conditions
  • Managing sarcoidosis, tuberculosis, or other systemic diseases where present

Symptom Relief and Supportive Care

Common treatment measures include:

  • Bed rest and leg elevation
    • Helps relieve pressure
    • Reduces swelling and pain
  • Support stockings or bandages
    • Provides gentle compression
    • Supports the legs, especially useful in people who stand for long periods at work
  • Alternating hot and cold compresses
    • Can ease pain and reduce inflammation
  • Non-steroidal anti-inflammatory drugs (NSAIDs)
    • Such as ibuprofen or naproxen (used cautiously and under medical guidance)
  • Corticosteroids
    • Oral or topical steroids may be used to reduce inflammation in more severe cases
    • Typically prescribed and monitored by a healthcare provider

Other medications that have been reported as helpful in some cases include:

  • Dapsone
  • Colchicine
  • Hydroxychloroquine
  • Erythromycin

These are usually considered when erythema nodosum is recurrent, severe, or associated with another inflammatory condition, and they should only be used under close supervision by a specialist.

Living With Erythema Nodosum in West Michigan

For people in Grand Rapids and the surrounding West Michigan region:

  • Cold weather and long winters can increase leg discomfort, especially when walking on snow or ice. Warm, supportive clothing and proper footwear can help.
  • Rest is important. Standing for long hours, heavy exercise, or frequent stair climbing may worsen pain and delay healing.
  • Follow-up care is essential to monitor for any underlying conditions such as sarcoidosis, TB, or inflammatory bowel disease.

Because erythema nodosum can sometimes be a sign of a more serious underlying illness, ongoing communication with your Grand Rapids healthcare team is important.

When to See a Doctor in Grand Rapids

Contact a healthcare provider if you notice:

  • New red, painful lumps on your shins or other parts of your legs
  • Skin changes that change color from red to purple to yellowish over weeks
  • Joint pain, especially in the knees or ankles
  • Fever, fatigue, or recent sore throat along with skin changes

Seek urgent care or emergency evaluation if you have:

  • Difficulty breathing
  • High fever
  • Severe pain or rapidly spreading redness

Local Resources in Grand Rapids, MI

If you suspect you have erythema nodosum or another skin condition, you can seek help from:

  • Primary Care Providers and Urgent Care Clinics
    • Available throughout Grand Rapids through Spectrum Health, Trinity Health Grand Rapids, Metro Health, and Mercy Health
  • Dermatologists
    • Hospital-affiliated dermatology clinics and private practices in the Grand Rapids area
  • Kent County Health Department
    • Offers resources for infectious disease testing and public health services
  • Grand Rapids Public Health Resources
    • Community clinics and programs that can help connect you with affordable care

Key Points About Erythema Nodosum in Grand Rapids

  • Erythema nodosum appears as red, tender lumps, most commonly on the shins or lower legs.
  • It is three times more common in women and usually affects adults between 20 and 45 years.
  • The condition is an immune system reaction, often triggered by infections, medications, or inflammatory diseases.
  • In about 20% of cases, the trigger remains unknown.
  • Even with treatment, the nodules typically take 3 to 6 weeks to resolve.
  • Proper evaluation by a Grand Rapids healthcare provider is important to:
    • Confirm the diagnosis
    • Identify any underlying cause
    • Provide appropriate treatment and follow-up

If you live in Grand Rapids or West Michigan and notice symptoms that could be erythema nodosum, schedule an appointment with your primary care provider or a local dermatologist for an accurate diagnosis and personalized treatment plan.