ERYTHEMA NODOSUM |
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DESCRIPTIONErythema nodosum is an inflammatory disease of the skin and tissue under the skin, characterized primarily by painful red nodules on the legs. It is not contagious. The skin of the legs, especially the areas over the large bone in the lower leg, is involved. The disease occasionally involves the arms or other areas. Erythema nodosum is most likely in females beginning at age 12.
Appropriate health care includes:
Physician's monitoring of general condition and medications.
Self-care after diagnosis.
SIGNS & SYMPTOMS
Nodules with the following characteristics:
Nodules are red, painful or tender, and warm.
Nodules are large (4cm to 10cm). Usually no more than 6 nodules appear on your child at a time.
Nodules usually occur on the front of the child's lower legs. They appear on one side and then the other.
Nodules usually appear suddenly. They are often accompanied by fever and swollen, red, tender ankles and knees.
Nodules change color from pink to red to blue to brown over 7 to 10 days.
CAUSES
Sometimes unknown. Known causes include:
Use of drugs, such as birth-control pills (especially those high in estrogen), sulfonamides, iodides, and bromides.
Preceding infection, including streptococcus (most common), coccidioidomycosis, histoplasmosis, sarcoidosis, blastomycosis, tuberculosis, and yersinia infections (See Glossary).
Autoimmune disease.
Chronic bowel inflammation.
Dysproteinemia (See Glossary).
Consumption of foods with food dyes or preservatives.
RISK FACTORS
Pregnancy.
PREVENTING COMPLICATIONS OR RECURRENCERemove or treat the cause of your child's illness, if it can be identified.
BASIC INFORMATION
MEDICAL TESTS
Your own observation of symptoms.
Medical history and physical exam by a doctor.
Laboratory studies, such as anti-streptococcal titre (See Glossary).
X-rays of the child's chest to detect sarcoidosis or tuberculosis.
POSSIBLE COMPLICATIONSRarely, erythema nodosum can indicate a hidden malignancy in the child's gastrointestinal tract, liver, or lung.
PROBABLE OUTCOME
Individual nodules on your child diminish in size and tenderness and heal in 10 to 20 days. However, others may begin. The disease may last several months. Once it disappears, erythema nodosum probably will not return. Treatment hastens recovery.
TREATMENT
HOME CARE
Elevate the child's legs whenever possible.
Use elastic wrap or support stockings on your child's leg.
Use wrapped or immersion soaks to hasten healing and relieve your child's discomfort. Warm-water soaks are usually more soothing for pain or inflammation. Cool-water soaks feel better for itching.
MEDICATION
For minor discomfort, use non-prescription drugs such as acetaminophen.
Your doctor may prescribe a non-steroidal anti-inflammatory drug or cortisone drugs to reduce inflammation.
See Medications section for information regarding medicines your doctor may prescribe.
ACTIVITY
Your child should rest in bed as much as possible with the legs elevated. Overexertion will cause lesions to recur. When symptoms subside, the child can resume normal activity slowly. Allow 3 weeks for recovery.
DIET & FLUIDS
No special diet.
OK TO GO TO SCHOOL?Yes. This condition is not contagious to others.
CALL YOUR DOCTOR IF
Your child has symptoms of erythema nodosum.
The following occurs during treatment:
-- Symptoms don't improve after 3 days of treatment.
-- Temperature rises to 101F (38.3C).
Any new symptoms arise which you think may be due to the disorder or the medications prescribed.
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