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Erythema nodosum

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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.

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Authors and Affiliations

  1. Department of Pediatrics, The Alberta Children’s Hospital, The University of Calgary, #200, 233-16th Avenue NW, Calgary, AB, T2M 0H5, Canada

    Alexander K. C. Leung

  2. Pediatric Institute, Kuala Lumpur General Hospital, Kuala Lumpur, Malaysia

    Kin Fon Leong

  3. Department of Pediatrics and Department of Dermatology and Skin Sciences, University of British Columbia, Vancouver, BC, Canada

    Joseph M. Lam

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  1. Alexander K. C. Leung
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AKCL wrote the first draft of the manuscript, contributed to drafting and revising the manuscript, as well as a statement of whether an honorarium, grant, or other form of payment was given to anyone to produce the manuscript. KFL and JML contributed to drafting and revising the manuscript. All the authors have seen and approved the final version submitted for publication and take full responsibility for the manuscript.

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Correspondence to Alexander K. C. Leung.

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Leung, A.K.C., Leong, K.F. & Lam, J.M. Erythema nodosum. World J Pediatr 14, 548–554 (2018). https://doi.org/10.1007/s12519-018-0191-1

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