Discussion
EED is a rare dermatosis commonly affecting adults between 30 and 60 years of age with no gender or racial predilection. Bullous lesions may occur occasionally.2 Palmar involvement, as seen in our case is rather an unusual manifestation of this rare disease. Ulcerated nodules on the palm are typical for HIV which is ruled out. The pathophysiology of EED is unknown. However, antigen-antibody immune complex deposition in cutaneous microvasculature is hypothesized as an inciting mechanism leading to chronic inflammation, fibrosis, and other sequelae of the disease.3 EED usually follows a chronic course. Initial diagnosis is difficult due to evolving nature of clinical and histologic findings. The histopathological examination at various stages shows nodular neutrophilic infiltrate, with features of leukocytoclastic vasculitis and subsequently, dermal fibrosis.2
EED can be the first indicator of underlying comorbidity necessitating the correct diagnosis, screening, and management of associated conditions. None of the above conditions was present in our patient. Medical treatment of choice is dapsone in early stage.3 In addition, anti-inflammatory agents like tetracyclines, niacinamide, non-steroidal anti-inflammatory drugs, methotrexate, chloroquine, colchicine, topical corticosteroids, plasmapheresis, and surgical intervention are other successful modalities of treatment reported.1 Nevertheless, resolution of skin lesions may occur spontaneously after years.