Clinical Example: Erythema Elevatum Diutinum treated with excision and skin grafting

Erythema elevatum diutinum (EED) is a rare, chronic skin disease which primarily involves the extremities. It is a chronic cutaneous leukocytoclastic vasculitis which is locally persistent because of immune mediators which become fixed in the dermis.

Effects vary as lesions progress from acute inflammation to fibrosis and ulceration. Lesions on the palms and soles of the feet are often very painful and tender.

Nonsurgical treatment options include dapsone and intralesional corticosteroids. This 42 year old patient had failed nonoperative treatment, and his painful, bulky, ulcerating hand lesions were treated with excision and skin grafting.

Radical excision, digital nerves preserved:

Typical microscopic findings of fibrosis and perivascular leukocytic infiltration.

Before:

Two months postop: