Histopathologic examination of the skin biopsy specimens demonstrated intraepidermal and subcorneal vesicles containing numerous neutrophils. In the superficial dermis, there were papillary dermal edema and a dense inflammatory infiltrate with many neutrophils. Leukocytoclasis was present, but there was no fibrin deposition within vessel walls.
Metronidazole therapy (500 mg twice a day) resulted in complete clearing of the skin lesions but had to be discontinued owing to ageusia. Dapsone therapy (50 mg/d) was then initiated, with good response, and there have been no more recurrences.
Diffuse Recurrent Tender Pustules, Papules, and Arthritis. Arch Dermatol. 1999;135(11):1409-1414. doi:10-1001/pubs.Arch Dermatol.-ISSN-0003-987x-135-11-dof9021