Case reportĀ
A 45-year-old male presented with asymptomatic, well-defined,
periarticular papules gradually evolving into nodules predominantly on
palms, dorsum of hands, and extensor surface of bilateral elbows for the
last five years (Figure 1 and 2). Examination revealed well-defined,
firm, yellowish to erythematous nodules measuring 0.5 to 5 cm in
diameter. On palms, lesions were crusted and ulcerated with surrounding
erythema (Figure 2). He visited multiple medical centers for his
complaint without improvement.
Complete blood count, liver function test, renal function test, thyroid
function test, serum electrolytes, anti-nuclear antibody (ANA),
Rheumatoid factor, Anti-cyclic citrullinated peptide (anti-CCP), uric
acid, and serological tests including HIV were within normal limit. An
X-ray of his hands revealed osteophytic changes without joint
involvement. Excisional biopsy of the nodule at elbow revealed epidermis
with compact orthokeratosis, dermis showing leukocytoclastic vasculitis
of small blood vessels along with well-circumscribed dermal nodule
composed of dense cellular infiltrates. (Figure 3). Reticular dermis
shows storiform fibrosis (Figure 3). Diagnosis of EED was made and he
was started on dapsone. A good response was seen in the first month but
he lost to follow-up.