case_images: PMC10868469_01
case_images: (a) Vegetative infiltrated plaques formed by coalescing pustules on the tips of the distal phalanges of the fingers. (b) Vegetative infiltrated mass with a few peripheral pustules of the left nostril.
case_images: 10.1177_2050313X241231535-fig1.jpg
case_images: PMC10868469_01_10.1177_2050313X241231535-fig1.jpg
case_images: fig1-2050313X241231535
case_images: We present the case of a 63-year-old woman with painful pustular plaques evolving for 4 months (Figure 1).
case_images: (a) Biopsy of a pustular lesion on the finger showed a papillomatous epidermal acanthosis with a subepidermal cleft. (White Arrow) and a deposit of neutrophils and eosinophils at the top of the papillae ((hematoxylin-eosin (HE), original magnification x100). (b) Subepidermal cleft with eosinophil and neutrophil infiltration (HE, x400). (c) Direct immunofluorescence analysis showed linear deposition of immunoglobulin (IgG and IgA) along the basement membrane.
case_images: 10.1177_2050313X241231535-fig2.jpg
case_images: PMC10868469_01_10.1177_2050313X241231535-fig2.jpg
case_images: fig2-2050313X241231535
case_images: One finger biopsy showed papillomatous epidermal acanthosis with a subepidermal blister (Figure 2). An inflammatory infiltrate composed of neutrophils and eosinophils was found on the dermal papillae (Figure 2). IgA at the junctional level (Figure 2). Indirect immunofluorescence was negative. Immunoblotting analyses were not performed in our case.
case_images: Resolution of finger lesions following treatment with dapsone and prednisone.
case_images: 10.1177_2050313X241231535-fig3.jpg
case_images: PMC10868469_01_10.1177_2050313X241231535-fig3.jpg
case_images: fig3-2050313X241231535
case_images: The patient was initially treated with high-dose prednisone (1 mg/kg daily), dapsone, tacrolimus ointment and clobetasol propionate cream with a good initial response (Figure 3).