Environmental sensitivity as a trigger of erythema nodosum and perimenopausal symptoms

A 45-year-old woman presented to the University of Arizona Integrative Medicine Clinic for advice on managing recurrent erythema nodosum (EN), along with recent onset perimenopausal symptoms. Her painful EN flares had occurred two to six times per year over the past 14 years, yet had attenuated over the past 5 years until recently, and she presented with bilateral EN lesions on the shins. An environmental exposure history revealed that a new plastic-containing water pot had been introduced at her office just prior to her latest EN flare. She was told to eliminate environmental exposure to plastics, including this new coffee pot. She eliminated exposures to heated plastics, and replaced her coffee pot with a stainless steel one. Within weeks of removing these potential environmental triggers, her EN lesions cleared completely, and her menses normalised. An unintentional re-exposure to plastics 2 months later resulted in an EN recurrence within 2 hours.