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November 2006

Tender Papules on the Hands—Diagnosis

Author Affiliations

Copyright 2006 American Medical Association. All Rights Reserved. Applicable FARS/DFARS Restrictions Apply to Government Use.2006

Arch Dermatol. 2006;142(11):1501-1506. doi:10.1001/archderm.142.11.1501-e

Histopathologic examination revealed a superficial and deep perieccrine and perivascular lymphohistiocytic inflammatory cell infiltrate with significant papillary dermal edema. No basal vacuolization was noted. The patient was treated with oral corticosteroids to reduce edema and educated regarding conservative protective measures. At the 1-month follow-up visit, all symptoms and papules had resolved, leaving only minor residual postinflammatory hyperpigmentation.

Idiopathic chilblains is a localized inflammatory skin disease involving acral skin that occurs after exposure to cold, wet weather.1-3 Chilblains presents as tender, erythematous-to-violaceous papules, nodules, or plaques that are usually located on the dorsal aspect of the fingers and toes and are less commonly found on the ears, nose, and lateral region of the thighs and buttocks. The lesions are tender, with associated edema, and severe cases may involve blistering or ulceration. Most cases resolve after several weeks.2,3 Associations include lupus erythematosus (chilblain lupus erythematosus or Hutchinson lupus), chronic myelomonocytic leukemia, viral hepatitis, human immunodeficiency virus infection, rheumatoid arthritis, cryoproteinemia, and use of weight reduction medications.1,2