Erythema elevatum diutinum involving palms and soles: a case report and literature review

Abstract

Erythema elevatum diutinum (EED) is a rare chronic inflammatory dermatosis and a part of the spectrum of cutaneous leukocytoclasticvasculitis. The most common site of involvement is extensor surface of the extremities, with a predilection for the skin overlying joints, particularly hands, feet, elbows and knees, as well as buttocks and Achilles tendons. Here we report a case of EED with atypical presentation involving palms and soles. The patient showed dramatic response to the treatment with prednisolone combined with Tripterygium wilfordii glycoside (TWP). The lesions improved significantly after three months of therapy. We will also review the atypical cases of EED that were previously published in English literature.

Keywords: Erythema elevatum diutinum; leukocytoclasticvasculitis; multiple myeloma.

Figure 1

Clinical picture of patient before and after treatment. A: Voilaceous nodule on erythematous base on left lateral foot; B: Reddish papular lesions with scales involving multiple toes; C: Dry scaly plaque with multiple hemorrhagic spots of different size on right foot; D: Papulonodular lesion on palms. Some papules have coalesced to form plaque; E: 3 months after treatment lesion disappeared leaving slight hyperpigmentation; F: 3 months after treatment the lesion improved; G: 3 months after treatment decrease in the thickness of plaques and nodules.

Figure 2

Histopathology. A: Histology shows diffuse neutrophil infiltration and fibroplasia in the dermis (Hematoxylin and eosin stain; original magnification ×4); B: Histology shows broken neutrophils and scanty eosinophils in the dermis (Hematoxylin and eosin stain; original magnification ×40).