A case of erythema elevatum diutinum associated with breast carcinoma

A 53‐year‐old woman diagnosed with invasive ductal‐type breast carcinoma was referred to our clinic with red–purple lesions on the hands and legs. She had neither pruritus nor pain. The first lesion developed on the dorsal hand. In the following days, new lesions appeared on the extensor surface of the legs. The patient had been treated with modified radical mastectomy and three courses of cyclophosphamide, adriamycin, and fluorouracil chemotherapy. Dermatologic examination revealed reddish‐violaceous papules and plaques ranging from a few millimeters to 2 cm in diameter, bilaterally located on the dorsal hands, especially over the metacarpophalangeal and interphalangeal joints ( Fig. 1). Multiple red–purple, circumscribed papules and plaques of various diameters were observed bilaterally over the shins ( Fig. 2). The largest of these plaques showed an annular configuration. The nails showed distal subungual keratosis and yellow discoloration. The rest of the physical examination was normal. 1Violaceous papules and plaques on the dorsal hands2Red–purple, circumscribed, papules and plaques over the shins A biopsy taken from the medial side of the shin revealed a predominantly neutrophilic infiltrate and nuclear dust around the dermal vessels and orthokeratotic stratum corneum ( Fig. 3). 3Predominantly neutrophilic infiltrate and nuclear dust around the dermal vessels and orthokeratotic stratum corneum (hematoxylin and eosin stain, ×100) Complete blood count, routine biochemical tests and fasting lipids, serologic tests of bacterial and viral agents, serum electrophoresis, and serologic profiles for autoimmune connective tissue diseases revealed normal results. Mycologic examination of nail clippings did not show any evidence of fungal infection. In the light of our clinical and histopathologic findings, a diagnosis of erythema elevatum diutinum was made, and the patient was given topical clobetasol propionate therapy. Complete clearance was achieved in 3 weeks ( Fig. 4). After six courses of cyclophosphamide, adriamycin, and fluorouracil chemotherapy, and radiotherapy, no recurrence of erythema elevatum diutinum lesions was observed. 4Healed lesion 3 weeks after high‐potency topical glucocorticoids