Soon after my diagnosis of thyrotoxicosis, I had a bout of erythema nodosum (EN). I hope never to have another.
If you’ve had EN, you’ll know exactly what it means: hot red lumps. Very, very painful hot red lumps.
Typically, these appear on the lower legs – on the shins – and the typical patient is young (aged 18-34) and more likely to be female than male. But of course there are many cases where the patient is atypical: for example, though I am female, I haven’t been 34 for a while, and my nodules were not (initially) on my shins!
It turns out to be a kind of panniculitis: an inflammation of the fatty layer in the skin. Sounds delightful, doesn’t it?
There may or may not be something that triggers it: in about half of cases, no triggers are found. But it can be triggered by an infection such as a streptococcal infection, by an underlying systemic condition such as sarcoidosis or TB, or even by some cancers. People with IBS or inflammatory bowel disease such as Crohn’s or ulcerative colitis can also get it. And occasionally it is triggered by pregnancy – or by antibiotics or the combined oral contraceptive pill. My medic niece tells me that they were taught it is related to the treatment for thyrotoxicosis…
It may be a one-time occurrence, or it may be recurrent. It may disappear on its own, or it may need medication. Typical recommendations for managing it include:
- bed rest / elevating the feet
- cool compresses
- support stockings
- anti-inflammatory medicines
Anecdotally, people say that going gluten free has helped them deal with it. There’s not much official evidence for this… I found a couple of papers online which discuss a few cases where someone with erythema nodosum has been found to have coeliac disease, and for whom, on switching to a gluten free diet, the EN has subsided.
Will it help you? I don’t know (I’m not a doctor) – but I’d have thought it worth a try.
Isn’t it astonishing how many things a gluten free diet can apparently help with?