Question

Do you know of any case report(s) on the treatment of erythema nodosum (EN) with methotrexate, infliximab, and ibuprofen?

Elke Stadlmaier, MD

Response from Robert Fox, MD

Although a search of Medline does not yield specific references to the use of infliximab or methotrexate for EN, it is likely that these medications are occasionally used for these conditions. In particular, EN can be associated with inflammatory bowel disease, and both infliximab and methotrexate are used in some patients with inflammatory bowel disease. Also, EN may be associated with sarcoidosis; in unusual cases when the disease is refractory to steroids, other disease-modifying agents may be used to help taper the steroids. EN may be associated with granulomatous disease such as tuberculosis, and there is increasing concern that tuberculosis can be reactivated by inhibitors of tumor necrosis factor (infliximab).

Ibuprofen, as well as other nonsteroidal anti-inflammatory agents, would be expected to provide symptomatic relief from the pain of EN. However, there are no published studies on these drugs as a therapy for the underlying pathogenic process(es) leading to EN.

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