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.