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September 2007

Tender Nodules on the Palms and Soles—Diagnosis

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Copyright 2007 American Medical Association. All Rights Reserved. Applicable FARS/DFARS Restrictions Apply to Government Use.2007

Arch Dermatol. 2007;143(9):1201-1206. doi:10.1001/archderm.143.9.1201-h

Examination of the hematoxylin-eosin–stained skin biopsy specimen from the erythematous tender nodule revealed a dense neutrophilic inflammatory infiltrate around the eccrine sweat glands.

Palmoplantar eccrine hidradenitis is a distinct entity with characteristic clinical findings. First reported in 1988, it was named traumatic plantar urticaria.1 Since then, 47 cases have been reported under 5 different names, including idiopathic (palmo)plantar hidradenitis and recurrent palmoplantar hidradenitis.2 It primarily affects healthy children and is characterized by an abrupt appearance of erythematous, tender nodules on the palms and soles that may last 1 to 4 weeks and cause considerable difficulty in walking.2 Most eruptions are limited to the plantar surfaces, although palmar lesions have been documented.3 Typical histiologic findings include a neutrophilic perieccrine infiltrate in the setting of varying degrees of superficial and deep perivascular infiltrates of neutrophils, lymphocytes, and histiocytes as well as septal panniculitis.3

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