Photoclinic Diagnosis: Erythema Elevatum Diutinum

A57-year-old woman was referred to our center because of a two-year history of confluent plantar vegetative and verrucous plaques. These papules were firm and not compressible. She had edema in both legs. Later multiple violaceous nodules appeared on the extensor surface of interphalangeal joints. They were red-brown, indurated, with smooth regular borders and surfaces. She had considerable weight loss. She had no other relevant past medical history. IgA paraproteinemia have been identified through laboratory investigation, but there was no clinical or laboratory evidence for infectious diseases including HIV, autoimmunity, or hematological abnormalities. Skin biopsies were performed from hand nodules and plantar lesions.