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Minimal Erythema Dose (MED) Testing
Published on: May 28, 2013
Erythema nodosum in children: a prospective study
T Kakourou1, P Drosatou, F Psychou
1First Department of Pediatrics, and the Department of Pathology, Athens University, Greece.
Insights
Erythema nodosum (EN) in children is often caused by infections, particularly beta-hemolytic streptococcus. While generally benign, Mycobacterium tuberculosis should be considered, and recurrences are rare.
Area of Science:
- Pediatric Dermatology
- Infectious Diseases
- Rheumatology
Background:
- Limited studies exist on pediatric erythema nodosum (EN), with most being retrospective.
- Understanding the epidemiology and clinical course of EN in children is crucial.
Purpose of the Study:
- To evaluate the epidemiology, etiology, clinical features, course, and prognosis of erythema nodosum in a pediatric cohort.
- To identify common causes and outcomes of EN in children.
Main Methods:
- A prospective study of 35 children diagnosed with erythema nodosum.
- Exclusion of four children with biopsy-proven leukocytoclastic vasculitis or eosinophilic cellulitis.
- Laboratory investigations to determine the etiology of EN.
Main Results:
- Infectious agents were identified as the cause in 77% of cases, with beta-hemolytic streptococcus being the most frequent (n=17).
- Mycobacterium tuberculosis, Crohn's disease, and Hodgkin's disease were less common etiologies.
- The mean duration of the rash was 11.5 days, and recurrences were exceptional (2 children).
Conclusions:
- Beta-hemolytic streptococcus is the predominant cause of EN in children in Greece.
- Mycobacterium tuberculosis remains a significant consideration for pediatric EN.
- Erythema nodosum in children typically follows a benign course with rare relapses.
Background:
The studies of series of children with erythema nodosum (EN) are limited and mostly retrospective.
Objective:
We evaluated the epidemiology, etiology, clinical manifestations, course, and prognosis of EN in children.
Methods:
Thirty-five children with EN (17 boys, 18 girls; mean age, 8.79 years) have been studied. Four excluded children proved, on biopsy, to have leukocytoclastic vasculitis (n = 3) or eosinophilic cellulitis (n = 1).
Results:
In 27 of the 35 children (77%), the etiology of EN was established by laboratory investigations. In 25 children the causative factor of EN was an infectious agent (including beta-hemolytic streptococcus [n = 17], and Mycobacterium tuberculosis [n = 2]), whereas in 2 patients, EN was associated with Crohn's disease in one and Hodgkin's disease in the other. In 8 of the 35 children (23%) the etiology of EN remained undetermined. The mean duration of the rash was 11.5 days. Recurrences were noted in only 2 children (1 episode in 1 child and 3 episodes in the other).
Conclusion:
Currently the most common provoking agent of EN in children in Greece is beta-hemolytic streptococcus. However, Mycobacterium tuberculosis should still be considered as a cause of the disorder. Also, the course of EN is benign and recurrences are exceptional.
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