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| Fig. 15.5 Erythema elevatum diutinum. Violaceous painful plaques on the dorsum of the hands. (Courtesy of the Fitzsimons Army Medical Center teaching files.) |
Erythema elevatum diutinum is a rare form of small vessel vasculitis that is confined to the skin. This chronic disorder is characterized by persistent, elevated, erythematous plaques and/or nodules, with a predilection for overlying joint spaces, such as the fingers, wrists, elbows, knees, ankles, and toes (Fig. 15-5). The lesions are usually painful. Biopsies of developed lesions demonstrate a chronic leukocytoclastic vasculitis with extensive tissue fibrosis. There may be an associated IgA or, less commonly, an IgG monoclonal gammopathy (immune complex disease) and an association with inflammatory bowel disease, rheumatoid arthritis, systemic lupus erythematosus, streptococcal infection, IgA monoclonal gammopathy, multiple myeloma, myelodysplasia, celiac disease, relapsing polychondritis, and human immunodeficiency virus (HIV) infection. Some patients have shown a dramatic response to dapsone.
Farley-Loftus R, Dadlani C, Wang N, et al: Erythema elevatum diutinum,
Dermatol Online J 14(10):13, 2008.
