A 53-year-old woman presented to her primary care physician in February 1995 complaining of painful, red papules on her right foot. A working diagnosis of herpes zoster was considered, and treatment with oral acyclovir (800 mg 5 times daily) was prescribed. The eruption resolved over the next several weeks, without further treatment, although the patient continued to complain of acral pain that was thought to represent postherpetic neuralgia. Approximately 2 months later, she experienced a recurrence of the rash on both feet. She was again seen by her primary care physician, who, at this point, referred her for dermatologic evaluation.
McAllister SM, Bornstein AM, Callen JP. Painful Acral Purpura. Arch Dermatol. 1998;134(7):789-791. doi:10.1001/archderm.134.7.789