Treatment of primary erythema nodosum when prior systemic therapies have not resolved recalcitrant pretibial nodules
In a subset of patients with primary erythema nodosum, recurrent or recalcitrant erythematous nodules on the pretibial area persist despite a full course of standard systemic management. When the goals of that earlier treatment line have not been achieved, a defined escalation pathway applies.
Prior treatment — what was tried and what it aimed to achieve
The preceding line of therapy may have included agents such as:
- Dapsone
- Hydroxychloroquine
- Minocycline or tetracycline
- Erythromycin
- Prednisone (for severe disease)
- Intralesional triamcinolone acetonide (for recalcitrant nodules)
The stated goal of that line — resolution of recurrent or recalcitrant erythematous nodules on the pretibial area — was not reached. This protocol addresses the next step.
Next-line treatment direction
This protocol involves biologic therapy from the TNF-α inhibitor class. The specific agents, sequencing, and complete dosing algorithm are contained in the full structured regimen.
Treatment goal
Resolution of recalcitrant erythematous nodules on the pretibial area.
References
Tumor necrosis factor-α inhibitors such as etanercept, adalimumab, and infliximab have been used in patients with recalcitrant disease.
DOI: 10.1007/s40257-021-00592-w
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