The authors conclusion and the editorial by cohen 2 tend to merge this condition with sweet syndrome ss. Erythema elevatum diutinum eed is a chronic leukocytoclastic vasculitis lcv that was initially described by hutchinson in 1888 and subsequently by bury in 1889. Pathology of erythema elevatum diutinum dr sampurna roy md. The lesions were violaceous, deep red, or brown and. Erythema elevatum diutinum patrick e burnett md phd, and susan burgin md dermatology online journal 94. Associations with underlying diseases are common, including autoimmune disease. These lesions are usually distributed on the extensor surfaces of the body. Erythema elevatum diutinum eed is classified within the small vessel vasculitis. The role of associated medical problems is controversial, and the exact pathogenesis of eed is unknown although an arthustype reaction to bacterial.
This signs and symptoms information for erythema elevatum diutinum has been gathered from various sources, may not be fully accurate, and may not be the full list of erythema elevatum diutinum signs or erythema elevatum diutinum symptoms. Successful surgical treatment of advanced erythema. Erythema elevatum diutinum an overview sciencedirect. The development of erythema elevatum diutinum in a patient with juvenile idiopathic arthritis under treatment with abatacept. The clinical manifestations are papules, plaques or nodules, which vary in coloration from reddish to purple, light brown and sometimes yellowish. The term diutinum is the latin word for long lasting. Erythema elevatum diutinum may be associated with celiac disease, ulcerative colitis, crohns disease, arthralgia, rheumatoid arthritis, myelodysplastic syndrome, hiv and hhv6 infections. Dermatitis herpetiformis is an autoimmune blistering disease characterized by granular deposits of immunoglobulin a iga in dermal papillae. E rythema elevatum diutinum is a rare leucocytoclastic vasculitis thought to be caused by an immune response that is characterized by inflammation, a rash, and scarring of small blood vessels of the skin a characteristic poorly defined rash develops symmetically in the skin of extremities where the vessels are inflamed. Erythema elevatum diutinum eed is chronic cutaneous vasculitis occurring in association with a variety of conditions including autoimmunity, infectious disease, and hematological abnormalities. A rare case of erythema elevatum diutinum presenting as diffuse. It is a rare, chronic and progressive disease affecting mostly extensor surfaces and skin overlying the joints.
Ab4 treatment of erythema elevatum diutinum eed in hivpositive afrocaribbean. Erythema elevatum diutinum eed is a rare chronic dermatosis and majority comprises adult patients. Erythema elevatum diutinum is a rare form of lcv that has its major manifestation in the skin. Journal of the american academy of dermatology vol. Erythema elevatum diutinum is een zeldzame variant van leukocytoclastische vasculitis waarbij rode, paarse, bruine of gele papels, nodi of plaques ontstaan. A 53yearold man with humanimmunodeficiencyvirus infection presents with a 2year history of nodules on the extensor surfaces of his extremities. Dermis erythema elevatum diutinum information on the.
Erythema elevatum diutinum eed is a rare skin disease characterized by indolent redtopurple papules and nodules, usually occurring. Erythema elevatum diutinum lesions tend to not leave scars, but areas of hyperpigmentation or hypopigmentation can be visible. Erythema elevatum diutinum is a rare condition representing a chronic leukocytoclastic vasculitis. Erythema elevatum diutinum two case reports, two different. Erythema elevatum diutinum eed is a distinctive form of chronic cutaneous vasculitis, belonging to the group of the neutrophilic dermatoses. Erythema elevatum diutinum is a rare chronic leukocytoclastic vasculitis of unknown etiology, characterized by red to reddish brown or purple papules and.
Erythema elevatum diutinum mimicking a vesiculobullous. Characteristic concentric erythematous bands forming a woodgrain appearance help distinguish erythema gyratum repens from other similar dermatoses, such. It is generally associated with autoimmune, neoplastic, and infectious processes. These lesions are located mainly on the knees, elbows, hands, feet, face, genitals and buttocks.
Erythema elevatum diutinum is a syndrome of vasculitis in which lesions, typically over the extensor surfaces, showed a mixed inflammatory infiltrate on biopsy. Erythema elevatum diutinum eed is a chronic form of cutaneous small vessel vasculitis consisting of violaceous, redbrown, or yellowish papules, plaques, or nodules that favor the extensor surfaces picture 1ad. However, the name erythema elevatum diutinum was first. Erythema elevatum diutinum presenting with vesicular.
Although the exact pathogenesis is unknown, it has been associated with a wide range of clinical illnesses including iga monoclonal gammopathy, myelodysplastic syndrome, rheumatoid arthritis, inflammatory bowel disease, streptococcal infection, and hiv. Erythema elevatum diutinum eed manifests on a clinicopathologic spectrum of chronic cutaneous small vessel vasculitis. Erythema elevatum diutinum eed is a rare type of skin disorder characterized as raised papules or plaques with a skin discoloration of red, purple, brown or yellow. The most prominent involvement occurs on the extensor surfaces, such as the knees, elbows, and dorsa of the hands fig. Erythema elevatum diutinum is equally seen in both genders. Treatment of erythema elevatum diutinum eed in hivpositive afro. Its incidence peaks between the third and sixth decades of life, and few cases have been reported in pediatric patients. Although the exact pathogenesis is unknown, patients usually have an underlying systemic medical problem such as malignancy, autoimmune disease or hiv. Sharma v, mahajan vk, mehta ks, chauhan ps, chander b.
Erythema elevatum diutinum is a form of vasculitis 835 it has been described as a paraneoplastic syndrome see also. Erythema elevatum diutinum sharma v, mahajan vk, mehta ks. We only request your email address so that the person you are recommending the page to knows that you wanted them to see it, and that it is not junk mail. Summary erythema elevatum diutinum is a rare chronic inflammatory skin disease of unknown etiology with a histopathology of a. Erythema elevatum diutinum eed belongs to the spectrum of cutaneous leukocytoclastic vasculitides.
He had been treated prior to hospitalisation with topical and oral antifungals and antibiotics without success. Pdf erythema elevatum diutinumassociated with loss of. Erythema elevatum diutinum mimicking a vesiculobullous disease lesions began in the hands and slowly progressed to affect the legs. Erythema elevatum diutinum eed is a rare, chronic, and. The name eed was first used by radcliffcrocker and williams who separated it into two groups. Erythema elevatum diutinum was first described in 1888 by hutchinson and in 1889 by bury. Erythema elevatum diutinum eed is a rare, chronic dermatosis that is characterized by redviolet to redbrown papules, plaques, and. Characteristic skin lesions are asymptomatic pain is occasional, plum colored erythemtous nodules, and plaques of variable size distributed symmetrically over extensors of extremities particularly over the joints, dorsal hands and feet, knees and elbows, buttocks and achilles tendon, and. In erythema elevatum diutinum, there is sparing of the papillary and periadnexal dermis figures 1, 2.
Some common areas eed is noted is on the backs of the hands, over joints, and on the buttocks. No mortality due to erythema elevatum diutinum has been reported. Eed is thought to be a form of immune complexmediated vasculitis, although its etiology remains unclear. There is a dense predominantly perivascular infiltrate composed largely of neutrophils. We read with interest the article by dicaudo and connolly 1 reporting 7 cases of neutrophilic dermatosis of the dorsal hands nddh. A 5mm punch biopsy was performed and histological examination revealed a leukocytoclastic vasculitis with neutrophilic perivascular infiltrates, dermal fibrin deposits and endothelial expansion.
Erythema nodosum is often associated with systemic diseases such as tuberculosis and rheumatic fever. Erythema elevatum diutinum can occur at any age but it appears that there is a peak in the sixth decade, with an equal sex ratio. Erythema elevatum diutinum involving palms and soles. We report a rare association of these two disorders. We believe, however, that the reported features of nddh better fit the diagnosis of erythema elevatum diutinum eed for the following reasons. Erythema elevatum diutinum is a chronic disease that usually evolves over a 5 to 10year period, at which point it may resolve. Erythema elevatum diutinum is a rare, chronic cutaneous vasculitis that presents with plaques or nodules on the extensor surfaces of extremities.
Golmia a, grinblat b, finger e, klieman c, assir f, scheinberg m. Furthermore, signs and symptoms of erythema elevatum diutinum may vary on an individual basis for each patient. A 60yearold woman with recurrent papular and vesiculobullous lesions of erythema elevatum diutinum responded to treatment with 100 mg of oral niacinamide three times a day and 250 mg of tetracycline hydrochloride four times a day. Erythema elevatum diutinum is a syndrome of vasculitis in which lesions, typically over the extensor surfaces, show a mixed inflammatory infiltrate on biopsy. The most common association in our series was with hypergammaglobulinemia. Erythema elevatum diutinum in association with dermatitis. Erythema elevatum diutinum eed is a rare type of leukocytoclastic vasculitis characterized by red, purple, brown, or yellow papules, plaques, or nodules. Histologic leukocytoclastic vasculitis is a key confirmatory diagnostic feature. Erythema gyratum repens egr is a figurate erythema that is believed to be a paraneoplastic condition in most cases. Erythema elevatum diutinum eed is a chronic and rare dermatosis that is considered to be a variant of leukocytoclastic vasculitis. Erythema elevatum diutinum can be thought of as a rare presentation of chronic cutaneous vasculitis. Erythema elevatum diutinum eed is a chronic form of leukocytoclastic vasculitis consisting of violaceous, redbrown, or yellowish papules.
Erythema elevatum diutinum primary care dermatology. Abstract erythema elevatum diutinum eed is a rare, chronic and treatable skin condition. Tender, bright red, slightly elevated nodules develop along the shins. Thank you for your interest in spreading the word about the bmj. Treatments for erythema elevatum diutinum including drugs, prescription medications, alternative treatments, surgery, and lifestyle changes. Vascular infiltration in the upper and middermis with predominant neutrophils and fewer lymphocytes, eosinophils and plasma cells figures 3, 4, 5. Erythema elevatum diutinum is a form of vasculitis. Erythema elevatum diutinum genetic and rare diseases. Perelman department of dermatology, new york university abstract. Although it is a chronic condition, most cases respond well to treatment with dapsone. Erythema elevatum diutinum eed is a rare skin disease that initially presents as leucocytoclastic vasculitis and later resolves with fibrosis.
On this basis, we confirmed the clinical suspicion of erythema elevatum diutinum eed. In women, it usually occurs at an earlier age and is accompanied by a rheumatologic disease. Unusual presentation of erythema elevatum diutinum with. Erythema elevatum diutinum with unusual clinical appearance. The only systemic manifestation is arthralgia, which occurs in 20% to 40% of patients.
A distinctive vasculitis with acuteonchronic features dear editor, a 53yearold man presented at our institution in june 2012 for a painful rash on his hands and feet. Erythema elevatum diutinum treated with niacinamide and. Erythema elevatum diutinum is a rare type of chronic cutaneous vasculitis characterized by red, purple, brown or yellow papules, plaques thick, red patches of skin, or nodules. Clinically, the lesions present as firm, tender, brownish, red to purple. Erythema elevatum diutinum eed is a rare neutrophilic dermatosis consisting of violaceous, brown or red papules, plaques, nodules, and occasionally vesicobullous lesions over the extensor surfaces of the joints and buttocks. Erythema elevatum diutinum eed is a rare form of cutaneous small vessel vasculitis characterised by red, purple, brown, or yellow papules, plaques, or nodules, presenting symmetrically on extensor surfaces, most commonly the hands, elbows, knees, and achilles tendons. Early lesions show necrotizing vasculitis with fibrinoid or lipid deposits in. Erythema elevatum diutinum eed is a leukocytoclastic vasculitis followed by repair and fibrosis. Erythema elevatum diutinum eed is a rare type of necrotising vasculitis that is characterised by red, purple, brown or yellow papules raised spot, plaques, or nodules, found on the backs of the hands, other extensor surfaces overlying joints, and on the buttocks. Special stains for mycobacteria and fungi were negative. We have reported a case with typical clinical presentation and histological aspect.
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