Erythema nodosum (Rose nodule) – Causes, Symptoms & Treatment

Erythema nodosum (knot rose)

Erythema nodosum or nodular rosette is an inflammatory skin disease that causes soft, nodular and painful inflammatory reactions in the subcutaneous fatty tissue. The nodular rosette occurs on the front sides of the lower legs. It is mainly women who are affected by erythema nodosum. A knot rose is often confused by doctors with erysipelas due to similar complaints and symptoms  and treated incorrectly.

What is erythema nodosum?

In the case of erythema nodosum, several nodular foci of inflammation develop on the lower legs – rarely on other parts of the body such as the buttocks. They can vary in size and merge into one another depending on the extent of the rosette knots.

The inflammation affects the subcutaneous fatty tissue. The tissue becomes inflamed for a variety of reasons, including bacterial infections, allergies , hormonal fluctuations or infected injuries. Erythema nodosum is a very painful condition, but in many cases it heals spontaneously without any treatment.

Initially, skin changes remain that resemble healing hematomas . It is possible for erythema nodosum to develop into a chronic condition triggered by another underlying condition. However, nodular rhinosis also occurs as an isolated disease.


Erythema nodosum has a number of very different causes. There is primarily an inflammation of the skin. The trigger for this, however, ranges from a bacterial infection in a completely different area of ​​the body to an isolated outbreak with no other triggers.

Aside from the isolated nodular rosette, it is believed that the inflammation is causing the skin to respond to some other ailment in the body. Erythema nodosum is often observed in connection with tonsillitis or intestinal inflammation . An allergic reaction or hormonal fluctuations caused by taking birth control pills and pregnancy also lead to the occurrence of erythema nodosum.

The characterization as an overreaction is supported by the fact that in most cases of nodular rhinosis there is also problem-free healing.

Symptoms, Ailments & Signs

An erythema nodosum becomes noticeable through the characteristic lumps in the subcutaneous fatty tissue. The growths are very painful to pressure, have blurred borders and can be felt from the outside. They reach a size of several centimeters and can grow into a larger lump as the disease progresses.

The surrounding tissue is reddened and overheated, when several growths merge, it often acquires a dark red color and is very sensitive to pressure. The color of the nodules changes from a reddish-purple hue to a yellowish-green color as the disease progresses. The inflammatory nodules occur mainly on both lower legs, especially in the area of ​​the edges of the tibia and ankles.

In severe cases, additional knots form on the knees, thighs, arms, and elbows. Accompanying the external characteristics, erythema nodosum is expressed by an increasing feeling of illness. Those affected often feel exhausted and tired, and suffer from fever or joint and muscle pain .

In the later stages, circulatory problems such as sweating or palpitations can also occur. If the lumps are scratched, an infection can develop. Thanks to the noticeable signs and symptoms, a knot rose can be diagnosed quickly and then treated in a targeted manner.

Diagnosis & History

Erythema nodosum is unproblematic in the diagnosis due to its typical nodule formation, the reddened skin and its occurrence, which is usually limited to the front of the lower legs.

Infections such as tonsillitis or intestinal diseases are asked about to clarify another underlying disease and, in case of doubt, are determined more precisely if the symptoms are unclear. A possible pregnancy should already be clarified because of the drug treatment of the erythema nodosum.

Usually, the nodule develops within a few days and then lasts for a period of two to three weeks. Eventually, the symptoms subside again and leave behind hematomas as consequential damage from the skin inflammation. During this period, a patient may feel exhausted and feverish. He tires easily and is less efficient due to the knot rose.

The painful skin changes in erythema nodosum impair mobility and generally cause physical and mental weakness.


Erythema nodosum, also known as knot rose, is one of the inflammatory skin diseases that often affect women. Soft, visibly reddened knots form in the subcutaneous fatty tissue on the front of the lower legs. If the affected areas swell, they start to hurt badly. The symptom is often confused with erysipelas. Those affected should therefore consult a doctor at the first sign.

The trigger of the disease can be a bacterial infection or an isolated outbreak, whereby the skin reacts to an endogenous side effect by means of inflammation. These include intestinal diseases, allergies, hormone fluctuations, oral contraceptives, tonsillitis and pregnancy. In most cases there are few complications, but the symptom can become chronic if there is another underlying disease or overreaction.

If erythema nodosum is not treated in time, not only the triggering cause worsens. The extremely pressure-sensitive nodules can swell under the skin surface to the size of the palm of your hand and cause not only severe reddening of the skin but also hematomas. Legs hurt, feel overheated, bloated and heavy.

Some sufferers experience bouts of fever and a significant drop in performance. If detected early, the medical countermeasures allow the knot rose to subside relatively without complications in about three weeks and at the same time treat the disease or infection that caused it. If the therapy is based on drugs based on cortisone, the existence of a pregnancy should be ruled out beforehand.

When should you go to the doctor?

If lumps form on the skin that are perceived as painful or uncomfortable, a doctor should be consulted. If the symptoms persist or occur repeatedly, it is advisable to consult a doctor. If symptoms of inflammation appear, a doctor should also be consulted.

With the formation of pus and the development of open wounds, germs can get into the organism and lead to further diseases. Since there is a risk of blood poisoning in severe cases, a doctor should be consulted as soon as you feel unwell or have an increased body temperature. If bodily fluids leak from the nodes, this is considered unusual and should be investigated.

If the lumps increase in size and circumference, a doctor should be contacted. If emotional or psychological problems set in, a doctor is needed. Persistent mood swings, a depressed mood, or social withdrawal are considered worrisome and should be discussed with a doctor. If the person concerned suffers from pain, swelling or joint problems, he needs a doctor.

If the symptoms lead to reduced movement or incorrect posture, a doctor’s visit is necessary. There is a risk of permanent damage, which should be prevented in good time. If there is a feeling of permanent warmth in the affected regions, it is advisable to consult a doctor.

Treatment & Therapy

Treatment is not absolutely necessary for erythema nodosum, but it should be done because of the considerable pain . Erythema nodosum usually responds well to anti- inflammatory drugs .

The use of an ointment containing cortisone for external application is helpful for faster healing of the skin changes. The oral administration of cortisone preparations can also shorten the course of the disease. Antibiotics are used when the underlying condition is a bacterial infection, such as tonsillitis. If it heals, the knot rose improves in direct connection.

Since the lower legs are affected in erythema nodosum, excessive strain on the legs should be avoided during the disease. Patients with nodular rhinosis find clothing that covers the lower legs painful. The areas are hot from inflammation and do not require additional stress from bandages or tight-fitting clothing.

An elastic bandage can only be applied to erythema nodosum once the symptoms have subsided. This promotes the regression of the haematomas and protects against unwanted pressure pain in the fading phase of the nodule rosette .

Outlook & Forecast

The prognosis of erythema nodosum is favorable. A large number of those affected do not require any therapy. The changes in the skin’s appearance heal spontaneously and without the need for treatment. There is usually an improvement within a few days, until a complete freedom from symptoms is achieved after a few weeks. For symptoms such as pain, medicines are given to relieve the symptoms. They support the healing process and improve health. In addition, ointments are administered that promote a regression of the skin changes.

Patients with a compromised immune system should seek medical treatment for a good prognosis. There is a risk that the pathogens will spread and existing symptoms will increase. In addition, without support, the organism is often not sufficiently able to prevent the bacteria from multiplying and to kill them off on its own. Help should be sought so that there is no further deterioration in the state of health and thus a worsening of the prognosis.

If complications arise, this can impair the chances of recovery. Mobility is restricted for the duration of the illness. Emotional problems can arise, leading to mental disorders in severe cases. If this course becomes apparent, unwanted delays can occur.


Erythema nodosum as a spontaneous overreaction to another underlying disease can hardly be prevented. This is different for patients who react to contact with an allergen with a nodular rosette. If the triggering factor of erythema nodosum is known, it should be avoided for the future.


In erythema nodosum, in most cases, only very few measures and options for aftercare are available to those affected. In this disease, early detection and subsequent treatment must be carried out in the first place. This is the only way to prevent further complications or complaints, since this disease cannot heal itself.

In the case of erythema nodosum, the focus is therefore on early detection of the disease. The earlier it is detected, the better the further course of the disease is usually. The treatment itself is usually carried out by taking medication, including antibiotics. The person concerned should take care to take it regularly and also to take the right dose.

Antibiotics should not be taken together with alcohol, otherwise their effect will be significantly weakened. Regular examinations by a doctor are also very important in order to identify other complaints at an early stage. The antibiotics should usually continue to be taken for a while after the symptoms have subsided. As a rule, the life expectancy of the affected person is not reduced by this disease.

You can do that yourself

Erythema nodosum generally heals within three to six weeks even without therapy. However, the nodular rose can cause severe pain that must be treated with various medications. Sometimes naturopathic remedies can also help , for example marigold ointment or treatments with arnica .

Parallel to the symptomatic treatment, it is important to identify the causative disease and treat it. It is best for those affected to keep a complaint diary in which the type and intensity of the symptoms are noted. This makes it easier for the doctor to diagnose the underlying condition. If the contraceptive pill is the cause of the erythema nodosum, you should switch to a different preparation in consultation with your gynaecologist . The three-month injection and the hormone spiral are also possible triggers that must be discontinued when a knot rose occurs.

In the case of painful lumps in the subcutaneous fatty tissue, an operation may be necessary. The doctor will decide this after a comprehensive examination and will tell the patient what preparatory measures he needs to take. In principle, rest and stress avoidance apply before and after an operation. A balanced diet can promote recovery and also relieve acute symptoms of erythema nodosum.

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Hello! I am Lisa Newlon, and I am a medical writer and researcher with over 10 years of experience in the healthcare industry. I have a Master’s degree in Medicine, and my deep understanding of medical terminology, practices, and procedures has made me a trusted source of information in the medical world.