Clinical and surgical therapeutic approach in Erithema Elevatum Diutinum\n- case report
Male patient, 56 years old, white, 18 months ago reported the development of soft and\nulcerated erythematous papules on his hands, which when squeezed, eliminated purulent\nexudate. He also presented with nodular lesions on his elbows. Physical examination\nrevealed yellowish, hardened erythematous nodules on the extensor surface of his elbows,\nmeasuring 1.7 cm in the right elbow and 3.5 cm in the left elbow (). On the dorsal surface of his right hand, linear\npapular-nodular lesions were observed ()\nand in the palmar region, there were numerous small ulcerations with purulent exudate\n(). Histopathological examination of\nthe biopsy of the nodule on his right elbow revealed irregular acanthosis, extensive\nfibrosis in the reticular dermis, interspersed with lymphohistiocytic inflammatory\ninfiltrate and focal areas of neutrophils with leukocytoclasia (). Culture of the purulent exudate showed no growth of\nmicroorganisms. The clinical and histopathological correlation led to the diagnosis of\nEED, late stage. Due to the frequent association with systemic diseases, laboratory and\nradiological exams (complete blood count with differential and platelet count, BUN,\ncreatinine, liver function tests, ESR, C-reactive protein, RF, ASO, ANA, ANCA, protein\nelectrophoresis, G6PD, VDRL, Fta-Abs, serology for viral hepatitis and HIV, tuberculin\ntest, hands and chest radiographs, urinalysis and 24h urine) were carried out, without\nany changes.\nTreatment with dapsone 100mg/day was initiated, and the palmar ulcerations healed. After\n4 months, the dose was reduced to 50mg/day. As the nodules in the elbows did not heal,\nfive sessions of infiltrations with dexamethasone 10mg/ml, 2 ml in each nodule, were\nperformed every fifteen days. However, the nodules on the elbows persisted, bothering\nthe patient while he performed his usual activities, so we opted for the surgical\nexcision of the nodules with excellent results (). One year after the surgery, the patient continued to use dapsone 50mg/day,\nwithout the development of new lesions.