Are You Confident of the Diagnosis? What you should be alert for in the history Patients with erythema elevatum diutinum EED usually present with a history of chronically persistent or intermittently recurrent skin lesions on the extensor surface of limbs and joints that may be asymptomatic, painful or pruritic, and may be associated with systemic symptoms, such as fever and arthralgia. Characteristic findings on physical examination On physical examination, characteristic findings are tender, persistent, red to reddish-brown or purple papules and nodules, which may coalesce in larger nodules or plaques with a tendency towards central clearing Figure 1. Typically there is a symmetrical acral distribution over the extensor aspects of extremities and joints Figure 2 , but larger plaques on the trunk may be seen Figure 3. Older lesions and partial resolution may result in yellowish-brown-colored papules, resembling xanthomata Figure 4. Resolved lesions usually leave residual pigmentation.
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What are the clinical features of erythema elevatum diutinum? Lesions usually start as papules or nodules on the backs of the hands. Other extensor surfaces affected include the knees, elbows, wrists, ankles, fingers and toes.
Buttocks, trunk, forearms, legs, palms and soles may also be affected. Lesions occurring on the face are indistinguishable from granuloma faciale. Lesions usually appear symmetrically. Colour of lesions progresses over time from yellow or pinkish to red, purple or brown. Lesions may enlarge during the day and go back to original size overnight. Rarely, blisters and ulcers may form. Lesions usually feel firm and freely movable over the underlying tissue.
EED can be symptomless or painful or cause an itching or burning sensation. Symptoms can worsen after exposure to cold. Arthralgia may be present. How is erythema elevatum diutinum diagnosed? Skin biopsy is the most important test to establish a diagnosis of EED; it shows leukocytoclastic vasculitis. What is the treatment for erythema elevatum diutinum? EED is a chronic and progressive skin disease that may last as long as 25 years. However, in some cases after evolving over a 5—10 year period it may spontaneously clear.
Medication can be used to limit the progression of the disease. Dapsone is considered the drug of choice for EED, mainly because of its rapid onset of action and clinical experience has shown good responses. However, lesions promptly recur following the withdrawal of the drug. Other drugs that have been occasionally reported to be effective include:.
Erythema Elevatum Diutinum
Clinically is characterized by red, purple, brown or yelow papules, plaques or nodules. These lesions are usually symmetrically distributed on the extensor surfaces of the extremities. Histologically, early lesions of erythema elevatum diutinum show leukocytoclastic vasculitis. We report three cases of erythema elevatum diutinum. Previous treatment with topical corticosteroids had been unsuccessful.
Erythema elevatum diutinum
What are the clinical features of erythema elevatum diutinum? Lesions usually start as papules or nodules on the backs of the hands. Other extensor surfaces affected include the knees, elbows, wrists, ankles, fingers and toes. Buttocks, trunk, forearms, legs, palms and soles may also be affected. Lesions occurring on the face are indistinguishable from granuloma faciale.