Erythema Nodosum In Children: Symptoms, Causes And Treatment
Erythema nodosum is not a pathology in itself, but a manifestation of a disease that causes it. Also, nodules develop on the skin, pain in the joints and there is a high temperature.
It is not contagious, and if the cause that originated it is not reached, its treatment is symptomatic and evolves spontaneously.
What are the causes of erythema nodosum in children?
The causes of this syndrome can be multiple. Consequently, according to the Spanish Association of Pediatrics, they are divided into infectious, non-infectious or idiopathic etiology.
Non-infectious causes
- Bacterial : streptococcal infections, tuberculosis, leprosy, M. coplasma pneumonia , Yersinia, Salmonella, Campylobacter, Tularemia, Bartonella (cat scratch disease), ñeptospirosis, psittacosis, brucellosis, lymphogranuloma venereum, rickettsiae, and shigella.
- Viral : infectious mononucleosis, hepatitis B, hepatitis C, HIV, Epstein-Barr virus, herpes simplex virus.
- Fungi : C occidioidomycosis, Blastomycosis, Histoplasmosis , ringworms.
- Parasites : amebiasis, giardiasis.
The infectious cause is the most related to cases that occur during childhood, so it should be the first thing to rule out.
Idiopathic cause
This type of origin is one in which no apparent cause can be identified. In turn, it is around 50% of the cases in which it is called idiopathic or primary erythema nodosum according to published reviews.
The treatment of this variant is only based on the administration of non-steroidal anti-inflammatory drugs to relieve discomfort.
Infectious causes
- Drugs : antibiotics (sulfonamides and penicillins).
- Various medications : oral contraceptives, bromides, iodides, TNF-alpha inhibitor.
- Malignancy : leukemia, lymphoma, occult neoplasms.
- Inflammatory bowel disease: Crohn’s disease, ulcerative colitis.
- Miscellaneous : pregnancy, Behcet’s disease, Whipple’s disease, sarcoidosis-Lofgren syndrome (a triad of erythema nodosum, acute arthritis, and hilar lymphadenopathy).
Symptoms of erythema nodosum in children
Erythema nodosum is a syndrome characterized by an acute, erythematous, nodular rash that occurs most frequently on the extensor aspect of the legs. It can even manifest itself on the forearms, arms, thighs and other parts of the body.
It can develop idiopathically or be linked to other systemic pathologies. The nodules are firm and come on suddenly. In turn, they are painful and deep on palpation. When it affects the pediatric population there is no gender predilection.
The evolution of the disease
Although the causative agent differs, the disease always develops in an evolutionary pattern. However, it never involves processes of necrosis, scarring or ulceration.
Prodromal phase
It is a non-specific period of time that can last between 3 to 6 days. In turn, this stage is characterized by high temperatures, pain in the large joints of the lower extremities or abdominal pain. A nasopharyngeal infection usually develops, in addition to a slightly altered general condition.
Stadium phase
The disease stage is consolidated in just 1 or 2 days. In addition, the predominant symptom is fever, along with joint pain that persists or increases from the previous phase.
Nodules 1–3 cm in diameter begin to become apparent on the extensor aspect of the legs, thighs, knees, and forearms. Likewise, nodules are characterized by being as follows:
- Little ones.
- Bilateral.
- Symmetrical.
- Bloodshot.
- Hot.
- Raised.
Occasionally, it presents with hilar adenopathy, ankle swelling and pain in the lesions that conditions the individual to lie down and elevate the legs to avoid discomfort.
Regressive phase
Erythema nodosum progresses spontaneously, but this process can be expedited with treatment of symptoms or with rest.
How is the diagnosis made?
Erythema nodosum is diagnosed by clinical findings in the child. In turn, the doctor can request complementary studies such as the following:
- Complete blood test.
- Chest X-ray.
- Rapid strep test.
- Mantoux test.
The biopsy of the lesion is subject to situations where the child’s clinic is not typical.
Treatment options for erythema nodosum in children
Treatment of erythema nodosum in children resolves spontaneously. However, it may require measures of rest with elevation of the lower limbs or measures to minimize symptoms.
Unlike adults, venous compression is not indicated in children to reduce pain. In turn, etiological treatment is essential in certain cases. NSAIDs (non-steroidal anti-inflammatory drugs) and paracetamol are part of the treatment of choice to greatly reduce symptoms.
Erythema nodosum and its evolution
In most cases, the prognosis for erythema nodosum in children is good. However, skin lesions often take months to resolve spontaneously. Consequently, they do not leave scars or hyperpigmented macules.
The evolution of the most serious erythema nodosum pictures take much longer to subside. In turn, a third of patients may have recurrences.
