Prevalence and Management of Erythema Nodosum in Teenagers
Prevalence in Teenagers
Erythema nodosum is relatively uncommon in the pediatric population, though it remains the most frequent type of panniculitis in children and teenagers. 1 The exact prevalence specifically in teenagers is not well documented in the literature, but several key epidemiological patterns have been observed:
- Erythema nodosum predominantly affects females, particularly during menacme (reproductive years) 2
- In a 12-year study from a tertiary pediatric hospital in Italy, 68 children were diagnosed with erythema nodosum 1
- Another study of 27 pediatric patients found that erythema nodosum occurs less frequently in children than in adults 3
Clinical Presentation
Erythema nodosum in teenagers presents with:
- Sudden onset of painful, erythematous, subcutaneous nodules
- Bilateral and symmetrical distribution, predominantly on the anterior tibial areas (shins)
- Nodules typically 1-5 cm in diameter
- Often accompanied by systemic symptoms including arthralgia and fatigue 4, 5
Etiology
The underlying causes of erythema nodosum in teenagers include:
Infections (most common identified cause):
Inflammatory conditions:
Medications:
Idiopathic:
Diagnostic Approach
Diagnosis is primarily clinical, with biopsy reserved for atypical cases 4. Basic workup should include:
- Complete blood count with differential
- Erythrocyte sedimentation rate and/or C-reactive protein
- Testing for streptococcal infection (throat swab culture, antistreptococcal O titers)
- Chest radiograph 4, 5
Additional testing should be guided by clinical suspicion:
- Inflammatory markers for IBD if GI symptoms present
- EBV serology if mononucleosis suspected
- Tuberculosis testing if exposure risk exists
Management
Treatment of erythema nodosum in teenagers should focus on identifying and addressing any underlying cause, with symptomatic management for pain and inflammation. 4
First-line treatment:
- Rest and elevation of affected limbs
- NSAIDs for pain management (ibuprofen, naproxen) 4
- Compression stockings to reduce edema 4
For recurrent or persistent cases:
- Colchicine is recommended, particularly when erythema nodosum is associated with Behçet's disease or inflammatory bowel disease 4
For severe cases unresponsive to first-line therapy:
- Short courses of systemic corticosteroids may be considered 4
- Immunomodulators (azathioprine, TNF-α antagonists) for resistant cases or frequent relapses, especially with underlying inflammatory conditions 4
Prognosis and Follow-up
- Most cases of erythema nodosum in teenagers have a benign course 3
- Treatment duration typically ranges from 2-12 weeks based on clinical resolution 4
- Regular follow-up is necessary to monitor for recurrence and evaluate for signs of underlying disease progression 4
- Prognosis is generally good, especially when any underlying cause is identified and treated appropriately 4
Special Considerations for Teenagers
- Hormonal factors may play a role in female teenagers, as suggested by the predominance in females during reproductive years 2
- School attendance and physical activities may be affected during acute episodes
- Psychological impact of visible skin lesions should be addressed
- NSAIDs should be used cautiously in teenagers with certain comorbidities 4
Common Pitfalls
- Misdiagnosis as cellulitis, infected insect bites, or minor trauma is common in emergency settings 4
- Alternative diagnoses should be considered when lesions are unilateral, have fluid collection, ulcerate, or when there is a history of trauma 4
- Failure to identify underlying causes can lead to recurrent episodes
- No statistical differences in clinical features or laboratory data can distinguish between idiopathic and secondary erythema nodosum, necessitating thorough investigation in all cases 1