PMC6015696_01
Clinical presentation: firm, indurated, erythematous papules, and nodules, with central pustules and vesicles on the head and scalp. Indurated papules on the palms of the hand. Erythematous pustules on the abdomen.
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Notably, a diffuse 1 cm papulopustular rash erupted over the scalp, head, neck, thorax, abdomen, and upper and lower extremities including the palmar and dorsal aspects of the hand (Figure 1).
Histopathological features. (a) Lesion of acute ruptured suppurative folliculitis. Papillary dermal edema and neutrophilic dermal infiltration. (b) Dense netrophilic infiltrate in the follicle. (c) Lesion of acute suppurative folliculitis.
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Biopsy of the pustule showed suppurative folliculitis, which is expected from a neutrophil driven process, consistent with azathioprine hypersensitivity (Figure 2).