Erythema Elevatum Diutinum

A 55-year-old man presented with a 3-month history of multiple yellowish-white pustules. These lesions were distributed symmetrically on the palmar and dorsal aspects of the fingers and hands, the extensor aspect of the elbows and the lateral aspect of the ankles. The patient denied arthritic and digestive complaints. Laboratory investigations showed complete blood count, C-reactive protein, erythrocyte sedimentation rate, liver and renal function tests, complement levels, rheumatoid factor, immunoglobulins, anti-streptolysin O titre, angiotensin-converting enzyme and urinalysis were within normal ranges; anti-nuclear antibodies, anti-neutrophil cytoplasmic antibodies, antiphospholipid antibodies, immunofixation electrophoresis, human immunodeficiency virus, hepatitis B virus and hepatitis C virus serology were negative.