Alexander K C Leung1, Kin Fon Leong2, Joseph M Lam3. 1. Department of Pediatrics, The Alberta Children's Hospital, The University of Calgary, #200, 233-16th Avenue NW, Calgary, AB, T2M 0H5, Canada. aleung@ucalgary.ca. 2. Pediatric Institute, Kuala Lumpur General Hospital, Kuala Lumpur, Malaysia. 3. Department of Pediatrics and Department of Dermatology and Skin Sciences, University of British Columbia, Vancouver, BC, Canada.
Abstract
BACKGROUND: Erythema nodosum can be associated with a number of systemic diseases. There is, however, a paucity of information in the pediatric literature on this condition. The purpose of this article is to familiarize pediatricians with the evaluation, diagnosis, and treatment of erythema nodosum. DATA SOURCES: A PubMed search was completed in Clinical Queries using the key terms "erythema nodosum". RESULTS: Clinically, erythema nodosum presents with a sudden onset of painful, erythematous, subcutaneous nodules mainly localized to the pretibial areas. Lesions are usually bilateral and symmetrical, ranging from 1 to 5 cm in diameter. Erythema nodosum may be associated with a variety of conditions such as infection, medications, sarcoidosis, pregnancy, inflammatory bowel disease, vaccination, autoimmune disease, malignancy, and miscellaneous causes. The condition is idiopathic in approximately 50% of cases. The diagnosis is mainly clinical with biopsy reserved for atypical cases. To evaluate for the underlying cause, some basic laboratory screening studies are worthwhile in most cases and include a complete blood cell count, erythrocyte sedimentation rate and/or C-reactive protein, throat swab culture, antistreptococcal O titers, and a chest radiograph. Other tests should be individualized, guided by the history and physical examination results. Most cases of erythema nodosum are self-limited and require no treatment. Bed rest and leg elevation are generally recommended to reduce the discomfort. Nonsteroidal anti-inflammatory drugs are the first-line treatment for pain management. CONCLUSIONS: As erythema nodosum is often a cutaneous manifestation of a systemic disease, a thorough search should be performed to reveal the underlying cause.
BACKGROUND:Erythema nodosum can be associated with a number of systemic diseases. There is, however, a paucity of information in the pediatric literature on this condition. The purpose of this article is to familiarize pediatricians with the evaluation, diagnosis, and treatment of erythema nodosum. DATA SOURCES: A PubMed search was completed in Clinical Queries using the key terms "erythema nodosum". RESULTS: Clinically, erythema nodosum presents with a sudden onset of painful, erythematous, subcutaneous nodules mainly localized to the pretibial areas. Lesions are usually bilateral and symmetrical, ranging from 1 to 5 cm in diameter. Erythema nodosum may be associated with a variety of conditions such as infection, medications, sarcoidosis, pregnancy, inflammatory bowel disease, vaccination, autoimmune disease, malignancy, and miscellaneous causes. The condition is idiopathic in approximately 50% of cases. The diagnosis is mainly clinical with biopsy reserved for atypical cases. To evaluate for the underlying cause, some basic laboratory screening studies are worthwhile in most cases and include a complete blood cell count, erythrocyte sedimentation rate and/or C-reactive protein, throat swab culture, antistreptococcal O titers, and a chest radiograph. Other tests should be individualized, guided by the history and physical examination results. Most cases of erythema nodosum are self-limited and require no treatment. Bed rest and leg elevation are generally recommended to reduce the discomfort. Nonsteroidal anti-inflammatory drugs are the first-line treatment for pain management. CONCLUSIONS: As erythema nodosum is often a cutaneous manifestation of a systemic disease, a thorough search should be performed to reveal the underlying cause.
Entities:
Keywords:
Drug-induced; Group A β-hemolytic streptococcal infection; Sarcoidosis; Subcutaneous pretibial nodules; Tuberculosis; Yersinia infection
Authors: Mohammed H Aly; Abdulrahman A Alshehri; Abdelgaffar Mohammed; Abdulrahman M Almalki; Walaa A Ahmed; Alhanouf M Almuflihi; Atheer A Alwafi Journal: Cureus Date: 2021-11-13
Authors: N Cameli; M Silvestri; M Mariano; L Bennardo; S P Nisticò; A Cristaudo Journal: J Eur Acad Dermatol Venereol Date: 2021-10-30 Impact factor: 6.166