Erythema nodosum (Pediatrics - PEDS)

Very low urgency
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Skin lesion consisting of the appearance of painful nodules or cysts with inflammatory signs (red and hot). They are usually located on the leg, on the anterior part of the tibia.

In most cases they appear as a consequence of a disease (mononucleosis, tuberculosis, streptococcus, chlamydia, hepatitis B, lupus erythematosus, lymphoma, rheumatic fever, Crohn's disease) or as a reaction of sensitivity to a drug (penicillins, oral contraceptives, sulfonamides...). On other occasions, the cause of its appearance is not known.

The most common symptoms include: fever, general malaise, digestive symptoms, joint pain and headache, fatigue and swelling of the affected area and joints.

Diagnosis is made by clinical history and physical examination. It may be necessary to perform a skin biopsy, a blood test and/or an X-ray to complete the study.

Treatment is aimed at correcting the triggering cause. It may also require antibiotics, standard or steroidal analgesics and anti-inflammatory drugs, and potassium iodide solution. Elevation of the affected extremity and application of indirect local cold may help reduce inflammation. Although the symptoms are uncomfortable, they disappear after approximately 6 weeks without scarring. It is a non-serious disease and recurrence is rare.

Bibliographic references
  1. J.J. Ríos, E. Sendagorta, M. J. González. Eritema nudoso. Med Clin 2009; 132(2):75-79
  2. D. Agüero, M. C. Cubero, O. Martín. Eritema nodoso, a propósito de un caso. Rev Pediatr Aten Primaria. 2009; 11(43):451-456.
  3. MedlinePlus. Rockville. 2017. Eritema nudoso; [citado el 28 de junio de 2017]. Disponible en: https://medlineplus.gov/spanish/ency/article/000881.htm
  4. UpToDate [Internet]. Waltham. 2017. Erythema nodosum; [citado el 28 de junio de 2017]. Disponible en: http://www.uptodate.com/contents/erythema-nodosum?source=search_result&search=eritema+nodoso&selectedTitle=1~71
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Symptoms

    Painful nodules below the knees


    Skin of the nodes is hot


    Tiredness / fatigue


    Fever / Feel very hot


    Skin alteration

Symptoms to watch out for

Pain that does not subside with analgesics.
Fever not relieved by antipyretics (paracetamol, ibuprofen)
History of immunodeficiency (HIV, Diabetes Mellitus, oncological disorders, long-term corticosteroid consumption).

Self-care

Take over-the-counter pain relievers or anti-inflammatories.
Keep the limb raised
Relative rest, rest until symptoms subside.
Use compression bands or tights.