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Detailed information of ERYTHEMA NODOSUM
ERYTHEMA NODOSUM
DEFINITION:
A disorder characterized by the development of painful,
erythematous nodules most frequently over the shins.
EPIDEMIOLOGY:
- incidence: ?
- age of onset:
- rarely before age 6 years; peak in 3rd decade
- risk factors:
PATHOGENESIS:
- exposure to a variety of stimuli can produce the
characteristic lesion of Erythema Nodosum:
- streptococcal infection most commonly implicated
- Cat-Scratch Fever, Psittacosis, Tularemia, TB,
Leptospirosis, Yersinia infections
2. Viral
3. Fungal
- Blastomycosis, Coccidioidomycosis, Histoplasmosis
2. Drugs
- sulfonamides
- birth control pill (estrogen-containing)
3. Systemic Illnesses
- Behcet Syndrome
- Crohn's Disease
- Cystic Fibrosis
- Sarcoidosis
- SLE
- Ulcerative Colitis
- Vasculitis
CLINICAL FEATURES:
- may precede or accompany rash
- arthralgias, fever, malaise
- those associated with the underlying disorder
2. Cutaneous Manifestations
- over the first 1-2 weeks
- appear in crops over 3-6 weeks
- painful, indurated, shiny, erythematous, hot, elevated
ovoid nodules between 1-3 cm in diameter - shins > calves,
thighs, buttocks, upper extremities
2. Later Manifestation
- induration decreases and purple colour replaced by a
brown discolouration without ulcer or scar formation
INVESTIGATIONS:
- elevated ZSR and acute phase reactants
- rising antibody titres to specific infection
- streptococcal-induced erythema nodosum may be associated
with an elevated IgE
2. Imaging Studies
- hilar adenopathy
- evidence of TB or fungal infections
3. Other
- positive cultures and/or skin testing
MANAGEMENT:
- salicylates for symptomatic relief
- corticosteroids may be beneficial although may be
contraindicated with some underlying disorders
2. Prognosis
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Pediatric Database - ERYTHEMA NODOSUM
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