PMC8326609_01
Clinical photographs of bilateral upper extremities with violaceous papules and nodules. (A, C) Right hand and (B) left hand at initial clinical presentation. (D) Left hand, third digit, dorsum proximal interphalangeal (PIP) joint prepped and marked for biopsy. (E) Left hand, fifth digit, neutrophilic dermatosis ulcerated lesion on dorsum surface extending from metacarpophalangeal joint to the PIP joint.
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One centimeter lesion with edematous base over the left middle finger over the dorsum of the proximal interphalangeal joint was also noted (Figure 1). The lesion measured 2 cm x 1 cm appearing on the medial left index finger extending from proximal to the medic carpal phalangeal joint to just proximal of the proximal interphalangeal joint (Figure 1E).
The microscopic findings of skin biopsy show the extensive dermal infiltration of neutrophils without vasculitis. The epidermis is spared. Hematoxylin-eosin stain. Magnification: (A) 4x, (B) 10x, (C) 10x, and (D) 40x.
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Vasculitis was not observed (Figure 2).