Erythema nodosum

• Published in: World journal of pediatrics : WJP Vol. 14; no. 6; pp. 548 - 554
• Main Authors: Leung, Alexander K. C., Leong, Kin Fon, Lam, Joseph M.
• Format: Journal Article
• Language: English
• Published: Hangzhou Childrens Hospital, Zhejiang University School of Medicine 01.12.2018; Department of Pediatrics,The Alberta Children's Hospital,The University of Calgary,#200,233-16th Avenue NW,Calgary,AB T2M 0H5,Canada%Pediatric Institute,Kuala Lumpur General Hospital,Kuala Lumpur,Malaysia%Department of Pediatrics and Department of Dermatology and Skin Sciences,University of British Columbia,Vancouver,BC,Canada
• Subjects: Anti-Inflammatory Agents, Non-Steroidal - therapeutic use; Bed Rest; Clinical Laboratory Techniques; Critical Care Medicine; Diagnosis, Differential; Erythema Nodosum - diagnosis; Erythema Nodosum - etiology; Erythema Nodosum - therapy; Humans; Imaging; Intensive; Maternal and Child Health; Medicine; Medicine & Public Health; Pain Management; Pediatric Surgery; Pediatrics; Prognosis; Radiology; Review Article; Stockings, Compression; Surgery; Group A β-hemolytic streptococcal infection; Tuberculosis; Sarcoidosis; Drug-induced; Yersinia infection; Subcutaneous pretibial nodules
• ISSN: 1708-8569; 1867-0687
• DOI: 10.1007/s12519-018-0191-1

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.