Regarding the 10 yo girl with red 'papules' on the extensor region of
the extremities, I think this probably is e. nodosum if the 'papules'
are are larger than 10-15 mm or so. I think screening for rheumatologic
or streptococcal causes is reasonable, but most of the time this is a
self limited exanthem induced by some virus or other immunogen without
significant associated pathlogy or sequelae. Therefore, I wouldn't have
her on steroids, salicyclates or antibiotics at this point.
Jay Fisher MD
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