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Erythema Elevatum Diutinum

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Neutrophilic Dermatoses
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Abstract

Erythema elevatum diutinum can be thought of as a rare presentation of chronic cutaneous vasculitis. Although the exact pathogenesis is unknown, it has been associated with a wide range of clinical illnesses including IgA monoclonal gammopathy, myelodysplastic syndrome, rheumatoid arthritis, inflammatory bowel disease, streptococcal infection, and HIV. Lesions typically present as asymptomatic, red-brown papules and nodules symmetrically distributed with a predilection for skin overlying joints, buttocks, and the Achilles tendon. Dapsone is considered first-line treatment.

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References

  1. Hutchinson J. On two remarkable cases of symmetrical purple congestion of the skin in patches, with induration. Br J Dermatol. 1888;1:10–5.

    Google Scholar 

  2. Bury JS. A case of erythema with remarkable nodular thickening and induration of the skin associated with intermittent albuminuria. Illus Med News. 1889;3:145.

    Google Scholar 

  3. Radcliffe-Crocker H, Williams C. Erythema elevatum diutinum. Br J Dermatol. 1894;6:1–9.

    Google Scholar 

  4. Patnala GP, Sunandini AP, Rayavarapu R, Yandapalli PS. Erythema elevatum diutinum in association with IgA monoclonal gammopathy: a rare case report. Indian Dermatol Online J. 2016;7(4):300–3. https://doi.org/10.4103/2229-5178.185472.

    Article  PubMed  PubMed Central  Google Scholar 

  5. Wilkinson SM, English JS, Smith NP, Wilson-Jones E, Winkleman RK. Erythema elevatum diutinum: a clinicopathological study. Clin Exp Dermatol. 1992;17:87–93.

    Article  CAS  PubMed  Google Scholar 

  6. Grabbe J, Haas N, Möller A, Henz BM. Erythema elevatum diutinum—evidence for disease-dependent leucocyte alterations and response to dapsone. Br J Dermatol. 2000;14:415–20.

    Article  Google Scholar 

  7. Katz SI, Gallin JI, Hertz KC, Fauci AS, Lawley TJ. Erythema elevatum diutinum: skin and systemic manifestations, immunologic studies, and successful treatment with dapsone. Medicine (Baltimore). 1977;56:443–55.

    Article  CAS  Google Scholar 

  8. Cream JJ, Leven GM, Calnan CD. Erythema elevatum diutinum: an unusual reaction to streptococcal antigen and response to dapsone. Br J Dermatol. 1971;84:393–9.

    Article  CAS  PubMed  Google Scholar 

  9. Wolff HH, Scherer R, Maciejewski W, Braun-Falco O. Erythema elevatum diutinum. II. Immunoelectronmicroscopical study of leukocytoclastic vasculitis within the intracutaneous test reaction induced by streptococcal antigen. Arch Dermatol Res. 1978;261:17–26.

    Article  CAS  PubMed  Google Scholar 

  10. Ayoub N, Charuel JL, Diemert MC, Barete S, André M, Fermand JP, et al. Antineutrophil cytoplasmic antibodies of IgA class in neutrophilic dermatoses with emphasis on erythema elevatum diutinum. Arch Dermatol. 2004;140:931–6.

    Article  CAS  PubMed  Google Scholar 

  11. Shimizu S, Nakamura Y, Togawa Y, Kamada N, Kambe N, Matsue H. Erythema elevatum diutinum with primary Sjögren syndrome associated with IgA antineutrophil cytoplasmic antibody. Br J Dermatol. 2008;159(3):733–5. https://doi.org/10.1111/j.1365-2133.2008.08676.

    Article  CAS  PubMed  Google Scholar 

  12. de Boysson H, Martin Silva N, de Moreuil C, Néel A, de Menthon M, Meyer O, et al. Neutrophilic dermatoses in antineutrophil cytoplasmic antibody-associated vasculitis: a French multicenter study of 17 cases and literature review. Medicine (Baltimore). 2016;95:e2957. https://doi.org/10.1097/MD.0000000000002957.

    Article  CAS  Google Scholar 

  13. Adachi A, Komine M, Murata S, Tsuda H, Kawahara Y, Morimoto A, et al. Pediatric case of microscopic polyangiitis with skin manifestations resembling vesiculobullous type erythema elevatum diutinum with immunoglobulin A antineutrophil cytoplasmic antibody. J Dermatol. 2016;43(11):1377–8. https://doi.org/10.1111/1346-8138.13394.

    Article  PubMed  Google Scholar 

  14. Kövary PM, Dhonau H, Happle R. Paraproteinaemia in erythema elevatum diutinum. Arch Dermatol Res. 1977;260:155–8.

    Article  PubMed  Google Scholar 

  15. Yiannias JA, el-Azhary RA, Gibson LE. Erythema elevatum diutinum: a clinical and histopathologic study of 13 patients. J Am Acad Dermatol. 1992;26:38–44.

    Article  CAS  PubMed  Google Scholar 

  16. Kavanagh GM, Colaco CB, Bradfield JW, Archer CB. Erythema elevatum diutinum associated with Wegener’s granulomatosis and IgA paraproteinemia. J Am Acad Dermatol. 1993;28:846–9.

    Article  CAS  PubMed  Google Scholar 

  17. Barzegar M, Davatchi CC, Akhyani M, Nikoo A, Daneshpazhooh M, Farsinejad K. An atypical presentation of erythema elevatum diutinum involving palms and soles. Int J Dermatol. 2009;48:73–5. https://doi.org/10.1111/j.1365-4632.2009.03867.

    Article  PubMed  Google Scholar 

  18. Nair SR, Viswanath V, Sonavane AD, Doshi AC, Parab MG, Torsekar RG. Erythema elevatum diutinum with verrucous carcinoma: a rare association. Indian J Dermatol Venereol Leprol. 2010;76:420–2. https://doi.org/10.4103/0378-6323.66595.

    Article  PubMed  Google Scholar 

  19. Thomas CL, Ffolkes L, Akhras V. A case of mistaken identity: unilateral erythema elevatum diutinum associated with IgA paraproteinaemia. Clin Exp Dermatol. 2015;40:761–4. https://doi.org/10.1111/ced.12622.

    Article  CAS  PubMed  Google Scholar 

  20. Wahl CE, Bouldin MB, Gibson LE. Erythema elevatum diutinum: clinical, histopathologic, and immunohistochemical characteristics of six patients. Am J Dermatopathol. 2005;27:397–400.

    Article  PubMed  Google Scholar 

  21. Atallah J, Garces JC, Loayza E, Carlson JA. Chronic localized fibrosing leukocytoclastic vasculitis associated with lymphedema, intralymphatic and intravascular lymphocytosis, and chronic myelogenous leukemia: a case report of unilateral erythema elevatum diutinum. Am J Dermatopathol. 2017;39(6):479–84.

    Article  PubMed  Google Scholar 

  22. Chow RK, Benny WB, Coupe RL, Dodd WA, Ongley RC. Erythema elevatum diutinum associated with IgA paraproteinemia successfully controlled with intermittent plasma exchange. Arch Dermatol. 1996;132:1360–4.

    Article  CAS  PubMed  Google Scholar 

  23. Soubeiran E, Wacker J, Hausser I, Hartschuh W. Erythema elevatum diutinum with unusual clinical appearance. J Dtsch Dermatol Ges. 2008;6:303–5. https://doi.org/10.1111/j.1610-0387.2008.06589.

    Article  PubMed  Google Scholar 

  24. Delaporte E, Alfandari S, Fenaux P, Piette F, Bergoend H. Erythema elevatum diutinum and chronic lymphocytic leukemia. Clin Exp Dermatol. 1994;19:188.

    Article  CAS  PubMed  Google Scholar 

  25. Dorsey JK, Penick GD. The association of hairy cell leukemia with unusual immunologic disorders. Arch Intern Med. 1982;142:902–3.

    Article  CAS  PubMed  Google Scholar 

  26. Morrison JG, Hull PR, Fourie E. Erythema elevatum diutinum, cryoglobulinaemia, and fixed urticaria on cooling. Br J Dermatol. 1977;97:99–104.

    Article  CAS  PubMed  Google Scholar 

  27. Collier PM, Neill SM, Branfoot AC, Staughton RC. Erythema elevatum diutinum—a solitary lesion in a patient with rheumatoid arthritis. Clin Exp Dermatol. 1990;15:394–5.

    Article  CAS  PubMed  Google Scholar 

  28. Walker KD, Badame AJ. Erythema elevatum diutinum in a patient with Crohn’s disease. J Am Acad Dermatol. 1990;22:948–52.

    Article  CAS  PubMed  Google Scholar 

  29. Buahene K, Hudson M, Mowat A, Smart L, Ormerod AD. Erythema elevatum diutinum—an unusual association with ulcerative colitis. Clin Exp Dermatol. 1991;16:204–6.

    Article  CAS  PubMed  Google Scholar 

  30. Rodriguez-Serna M, Fortea JM, Perez A, Febrer I, Ribes C, Aliaga A. Erythema elevatum diutinum associated with celiac disease: response to a gluten-free diet. Pediatr Dermatol. 1993;10:125–8.

    Article  CAS  PubMed  Google Scholar 

  31. Tasanen K, Raudasoja R, Kallioinen M, Ranki A. Erythema elevatum diutinum in association with coeliac disease. Br J Dermatol. 1997;136:624–7.

    Article  CAS  PubMed  Google Scholar 

  32. Chandrasekaran SS, Rai R, Vedachalam S, Dorairaj L, Palaniraman S. Erythema elevatum diutinum in association with dermatitis herpetiformis. Indian Dermatol Online J. 2014;5:48–50. https://doi.org/10.4103/2229-5178.126032.

    Article  PubMed  PubMed Central  Google Scholar 

  33. Bouaziz JD, Barete S, Le Pelletier F, Amoura Z, Piette JC, Francès C. Cutaneous lesions of the digits in systemic lupus erythematosus: 50 cases. Lupus. 2007;16:163–7.

    Article  CAS  PubMed  Google Scholar 

  34. Yamamoto T, Nakamura S, Nishioka K. Erythema elevatum diutinum associated with Hashimoto’s thyroiditis and antiphospholipid antibodies. J Am Acad Dermatol. 2005;52:165–6.

    Article  PubMed  Google Scholar 

  35. Marie I, Courville P, Levesque H. Erythema elevatum diutinum associated with dermatomyositis. J Am Acad Dermatol. 2011;64:1000–1. https://doi.org/10.1016/j.jaad.2009.08.037.

    Article  PubMed  Google Scholar 

  36. Yıldız F, Karakaş T, Açıkalın A, Taş DA, Erken E. Erythema elevatum diutinum coexisting with ankylosing spondylitis. Eur J Rheumatol. 2015;2:73–5.

    Article  PubMed  PubMed Central  Google Scholar 

  37. Cirvidiu DC, Elias BL, Jorge JC, Lira ML, Mandelbaum SH. Erythema elevatum diutinum and hypothyroidism: coincidence or causal relationship? An Bras Dermatol. 2015;90:561–3. https://doi.org/10.1590/abd1806-4841.20153284.

    Article  PubMed  PubMed Central  Google Scholar 

  38. LeBoit PE, Cockerell CJ. Nodular lesions of erythema elevatum diutinum in patients infected with the human immunodeficiency virus. J Am Acad Dermatol. 1993;28:919–22.

    Article  CAS  PubMed  Google Scholar 

  39. Shanks JH, Banerjee SS, Bishop PW, Pearson JM, Eyden BP. Nodular erythema elevatum diutinum mimicking cutaneous neoplasms. Histopathology. 1997;31:91–6.

    Article  CAS  PubMed  Google Scholar 

  40. Smitha P, Sathish P, Mohan K, Sripathi H, Sachi G. A case of extensive erosive and bullous erythema elevatum diutinum in a patient diagnosed with human immunodeficiency virus (HIV). Int J Dermatol. 2011;50:989–91. https://doi.org/10.1111/j.1365-4632.2010.04616.

    Article  PubMed  Google Scholar 

  41. Jose SK, Marfatia YS. Erythema elevatum diutinum in acquired immune deficiency syndrome: can it be an immune reconstitution inflammatory syndrome? Indian J Sex Transm Dis. 2016;37:81–4. https://doi.org/10.4103/0253-7184.180287.

    Article  Google Scholar 

  42. Drago F, Semino M, Rampini P, Lugani C, Rebora A. Erythema elevatum diutinum in a patient with human herpesvirus 6 infection. Acta Derm Venereol. 1999;79:91–2.

    Article  CAS  PubMed  Google Scholar 

  43. Hatzitolios A, Tzellos TG, Savopoulos C, Tzalokostas V, Kaiafa G, Psomas E, et al. Erythema elevatum diutinum with rare distribution as a first clinical sign of non-Hodgkin’s lymphoma: a novel association? J Dermatol. 2008;35:297–300. https://doi.org/10.1111/j.1346-8138.2008.00470.

    Article  PubMed  Google Scholar 

  44. Futei Y, Konohana I. A case of erythema elevatum diutinum associated with B-cell lymphoma: a rare distribution involving palms, soles and nails. Br J Dermatol. 2000;142:116–9.

    Article  CAS  PubMed  Google Scholar 

  45. Yilmaz F, Artaç M, Ciftçioglu MA, Yilmaz E. A case of erythema elevatum diutinum associated with breast carcinoma. Int J Dermatol. 2005;44:948–50.

    Article  PubMed  Google Scholar 

  46. Kohler IK, Lorincz AL. Erythema elevatum diutinum treated with niacinamide and tetracycline. Arch Dermatol. 1980;116:693–5.

    Article  CAS  PubMed  Google Scholar 

  47. Kanitakis J, Cozzani E, Lyonnet S, Thivolet J. Ultrastructural study of chronic lesions of erythema elevatum diutinum: “extracellular cholesterosis” is a misnomer. J Am Acad Dermatol. 1993;29:363–7.

    Article  CAS  PubMed  Google Scholar 

  48. Takahashi H, Fukami Y, Honma M, Ishida-Yamamoto A, Iizuka H. Successful combination therapy with dapsone and cyclosporine for erythema elevatum diutinum with unusual appearance. J Dermatol. 2012;39:486–7. https://doi.org/10.1111/j.1346-8138.2011.01331.

    Article  PubMed  Google Scholar 

  49. Yoshii N, Kanekura T, Higashi Y, Oyama K, Azagami K, Kanzaki T. Erythema elevatum diutinum manifesting as a penile ulcer. Clin Exp Dermatol. 2007;32:211–3.

    Article  CAS  PubMed  Google Scholar 

  50. Lekhanont K, Patarakittam T, Mantachote K, Waiyawatjamai P, Vongthongsri A. Progressive keratolysis with pseudopterygium associated with erythema elevatum diutinum. Ophthalmology. 2011;118:927–33. https://doi.org/10.1016/j.ophtha.2010.09.013.

    Article  PubMed  Google Scholar 

  51. Momen SE, Jorizzo J, Al-Niaimi FJ. Erythema elevatum diutinum: a review of presentation and treatment. J Eur Acad Dermatol Venereol. 2014;28:1594–602. https://doi.org/10.1111/jdv.12566.

    Article  CAS  PubMed  Google Scholar 

  52. Booth SA, Moody CE, Dahl MV, Herron MJ, Nelson RD. Dapsone suppresses integrin-mediated neutrophil adherence function. J Invest Dermatol. 1992;98:135–40.

    Article  CAS  PubMed  Google Scholar 

  53. Zacaron LH, Gonçalves JC, Curty VM, D’Acri AM, Lima RB, Martins CJ. Clinical and surgical therapeutic approach in erithema elevatum diutinum—case report. An Bras Dermatol. 2013;88:15–8. https://doi.org/10.1590/abd1806-4841.20132150.

    Article  PubMed  PubMed Central  Google Scholar 

  54. Mahoney MG, Wood MG, Wilson F. Erythema elevatum diutinum. Arch Dermatol. 1968;97:590–1.

    Article  CAS  PubMed  Google Scholar 

  55. Henriksson R, Hofer PA, Hörnqvist R. Erythema elevatum diutinum—a case successfully treated with colchicine. Clin Exp Dermatol. 1989;14:451–3.

    Article  CAS  PubMed  Google Scholar 

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Acknowledgements

We thank Omar Sangueza, MD, Professor of Pathology and Dermatology, Wake Forest University School of Medicine for photographs and histology.

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Tran, A.N., Jorizzo, J.L. (2018). Erythema Elevatum Diutinum. In: Wallach, D., Vignon-Pennamen, MD., Valerio Marzano, A. (eds) Neutrophilic Dermatoses. Springer, Cham. https://doi.org/10.1007/978-3-319-72649-6_4

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  • DOI: https://doi.org/10.1007/978-3-319-72649-6_4

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