What can cause painful bumps on the shins?
Ask the doctor
Q. I developed painful red bumps over my shins. My doctor has diagnosed me with erythema nodosum. What causes this? What can I expect?
A. Erythema nodosum (E. nodosum) is an uncommon condition. It appears as tender red bumps on the legs, usually on the shins. Once these bumps (or nodules) are recognized as E. nodosum, the doctor begins thinking about the causes.
There are many possible causes of this condition, including:
- a drug reaction (especially to sulfa drugs, penicillin, and birth control pills)
- pregnancy
- sarcoidosis (a disease that leads to inflammation and enlarged lymph nodes; it affects many of the body's organs)
- a streptococcal bacterial infection
- an immune reaction to a fungal infection, such as coccidiomycosis or histoplasmosis
- inflammatory bowel disease, such as ulcerative colitis or Crohn's disease.
Other symptoms that can be seen with E. nodosum include fever, joint aches, fatigue, and swollen lymph nodes.
The first evaluation of E. nodosum usually includes a chest x-ray and blood tests. The x-ray is done to look for one or more enlarged lymph nodes in the chest and abnormal markings in the lungs. Blood tests might not directly lead to a specific diagnosis, but the results can help determine what other evaluation may be necessary.
Your doctor will want to determine
- if you have any symptoms besides painful skin bumps
- what medications (including herbs and supplements) you take
- where you live and if you have travelled (histoplasmosis is seen in the Mississippi Valley; coccidioidomycosis is found in California and Arizona)
- if you have any lymph node swellings in your neck, armpits, next to your elbow, and/or in your groin.
If the chest x-ray shows swollen lymph nodes or certain changes in the lungs, the most likely diagnosis is sarcoidosis.
Your doctor may want you to see a dermatologist for a biopsy of the skin bumps. But E. nodosum can usually be diagnosed just by looking at them.
Your doctor will also consider other areas of your body for biopsy. He or she will look closely at your skin for new raised brown spots that might be sarcoid. If you have any lymph nodes that can be felt, one of these can be sampled.
If your chest x-ray is abnormal, your doctor may suggest a procedure to get a small piece of lung (bronchoscopy) or a piece of lymph node (mediastinoscopy).
Image: © Jose Luis Pelaez Inc/Getty Images
About the Author
Howard E. LeWine, MD, Chief Medical Editor, Harvard Health Publishing; Editorial Advisory Board Member, Harvard Health Publishing
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