From the Guidelines
Erythema nodosum in teenage females is most commonly caused by underlying conditions such as streptococcal infections, inflammatory bowel diseases, and medications, with approximately 30% of cases remaining idiopathic. The causes of erythema nodosum can be diverse, including:
- Infectious triggers like streptococcal infections, tuberculosis, and viral infections such as Epstein-Barr virus
- Medications, particularly oral contraceptives, sulfonamides, and penicillins
- Inflammatory bowel diseases, including Crohn's disease and ulcerative colitis, as noted in studies such as 1 and 1
- Sarcoidosis, although less common in teenagers
- Hormonal changes during puberty, which may contribute to susceptibility
When evaluating a teenage female with erythema nodosum, a comprehensive history should be taken, including recent infections, medication use, and symptoms of systemic diseases. Laboratory testing, such as complete blood count, throat culture, chest X-ray, and inflammatory markers, can help identify the underlying cause, which guides treatment. According to 1, diagnosis of erythema nodosum is made on clinical grounds, and treatment is usually based on that of the underlying condition, with systemic corticosteroids required in severe cases and immunomodulators or anti-TNF agents used for relapsing and resistant forms.
From the Research
Causes of Erythema Nodosum in Teenage Females
The causes of erythema nodosum in teenage females can be varied and include:
- Infections such as streptococcal pharyngitis 2, 3, 4, 5
- Systemic diseases like tuberculosis, sarcoidosis, inflammatory bowel disease, or cancer 2, 3, 4, 6, 5
- Medications, including oral contraceptives and certain antibiotics 2, 3, 4
- Pregnancy 3, 4
- Autoimmune disorders 3
- Malignancies 3
Identifiable Causes
The most common identifiable causes of erythema nodosum are:
- Streptococcal infections 2, 3, 4, 5
- Primary tuberculosis 4, 6, 5
- Sarcoidosis 2, 3, 4, 5
- Behçet disease 4
- Inflammatory bowel disease 2, 3, 4
- Drugs 2, 3, 4
- Pregnancy 3, 4
Diagnosis and Treatment
Diagnosis of erythema nodosum involves a comprehensive history and physical examination, laboratory tests, and biopsy 2, 3, 4. Treatment should be directed at the underlying associated condition, if identified 3, 4. Supportive care and pain management with nonsteroidal anti-inflammatory drugs can also be provided 2, 3, 4.