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July 2000

Chronic Pustular Eruption of the Thumbs

Author Affiliations

Copyright 2000 American Medical Association. All Rights Reserved. Applicable FARS/DFARS Restrictions Apply to Government Use.2000

Arch Dermatol. 2000;136(7):925-930. doi:

Microscopic examination of the biopsy specimen showed hyperkeratosis, mild parakeratosis, acanthosis, and elongation of rete ridges. A subcorneal pustule consisting of granulocytes, mononuclear cells, and fibrin was seen. The upper dermis contained mild edema and a mild perivascular mononuclear infiltrate.

Based on the clinical and histologic findings in this case, the diagnosis was ACH. Treatment with multiple topical regimens, including potent topical corticosteroids, calcipotriene ointment, tretinoin cream, and 5% fluorouracil cream, was initiated, with no significant improvement. Systemic treatments with colchicine (1.5 mg/d) and acitretin (0.75 mg/kg for 3 months) were unsuccessful as well.