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Article
August 1993

Ulcerated Nodules on the Elbows, Fingers, and Knees

Author Affiliations

Royal Hallamshire Hospital, Sheffield, England, and Chesterfield and North Derbyshire Royal Hospital, Chesterfield, England

Arch Dermatol. 1993;129(8):1045-1046. doi:10.1001/archderm.1993.01680290117020
Abstract

REPORT OF A CASE  A 59-year-old white man was referred with a 3-year history of purplish nodules that started on the elbows and spread to the knees, ankles, and fingers. Ill-defined violaceous plaques were present on the abdomen and upper thighs. One month before referral, some lesions had become painful and ulcerated (Figure 1), and some digital lesions had fissured (Figure 2). He had taken ibuprofen and allopurinol for chronic gout for 5 years. The physical examination was unremarkable. Laboratory investigations including complete blood cell count, hepatic and renal function studies, serum uric acid, and rheumatoid factor revealed normal or negative results. The chest roentgenogram was also normal. An incisional biopsy specimen of an early lesion was obtained (Figures 3 and 4).What is your diagnosis?

DIAGNOSIS:  Erythema elevatum diutinum (EED).

HISTOPATHOLOGIC FINDINGS AND CLINICAL COURSE  The skin biopsy specimen taken from

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