Erythema nodosum in Child
The eruption persists for 3-6 weeks and spontaneously regresses without ulceration, scarring, or atrophy.
EN occurs in boys and girls in equal proportions before puberty (it rarely occurs before age 2); however, after puberty, females are more frequently affected, as in the adult population. Recurrences with reappearance of the precipitating factors are reported.
More commonly associated infections:
- Streptococcus infection, especially pharyngitis
- Upper respiratory viruses (Epstein-Barr virus [EBV])
- Mycobacteria (tuberculosis [TB] and atypical)
- Coccidioidomycosis in endemic areas
- Yersinia, Shigella, Campylobacter, Salmonella sp. gastroenteritis
- Cat-scratch disease, Chlamydia, syphilis, pertussis, leprosy, and numerous other bacterial infections
- Hepatitis B, human immunodeficiency virus (HIV)
- Blastomycosis, histoplasmosis, sporotrichosis, Giardia
- Inflammatory bowel disease
- Behçet disease
- Oral contraceptives, sulfonamides, penicillins, cephalosporins, macrolide antibiotics
L52 – Erythema nodosum
32861005 – Erythema nodosum
- Primary infectious panniculitis (see panniculitis) occurs through septic seeding or direct inoculation of a variety of infectious organisms. Tissue culture and polymerase chain reaction (PCR) aids in diagnosis.
- Subacute migratory panniculitis is often more focal, painless, and unilateral.
- Nodular vasculitis / erythema induratum is typically on the posterior calves and associated with pulmonary tuberculosis.
- Pancreatic panniculitis favors the lower legs but is often ulcerated.
- Lupus panniculitis favors the face and upper trunk. Most cases are not associated with systemic lupus erythematosus.
- Panniculitis of dermatomyositis (abdomen, thighs, arms) is rare but may be the first manifestation of juvenile dermatomyositis.
- Granulomatous panniculitis is a manifestation of subcutaneous granuloma annulare or sarcoidosis.
- Post-steroid panniculitis is rare but exclusive to children. Occurs 1-10 days following withdrawal of systemic corticosteroids. May ulcerate and scar.
- Cold panniculitis typically presents on the cheeks ("popsicle panniculitis") but may occur on any body site exposed to cold temperatures. Lateral thigh involvement of horseback riders has been described.
- Injections, including iatrogenic and factitial.
- Alpha-1 antitrypsin deficiency panniculitis is extremely rare in children but has been reported as an initial manifestation of the disease. Lesions frequently ulcerate.