Erythema elevatum diutinum: A clinical and histopathologic study of 13 patients

Background: Erythema elevatum diutinum is a rare condition representing a chronic leukocytoclastic vasculitis. Objective: Clinical and laboratory features of the disease were reviewed to better understand the disease. Methods: The medical records and histopathologic slides of 13 patients with erythema elevatum diutinum were studied. Results: The lesions were violaceous, deep red, or brown and typically were papules or plaques. Lesions were most often located on the extensor surfaces of the extremities. Associated medical problems included 'hematologic abnormalities in six patients: IgA clonal gammopathies (four), multiple myeloma (one), and myelodysplasia (one). Erythema elevatum diutinum preceded the myeloproliferative disorders by an average of 7.8 years. All patients showed vasculitis. Leukocytoclasia was present in 27 of 35 specimens. The predominant cell type in the inflammatory infiltrate was polymorphonuclear leukocytes or a mixture of polymorphonuclear leukocytes and lymphocytes. Conclusion: The most significant finding of this study is the association of erythema elevatum diutinum with hematologic disease, most frequently an IgA monoclonal gammopathy.