Atypical Presenation of Erythema Elevatum Diutinum

Summary: Erythema Elevatum Diutinum (EED) is a rare chronic cutaneous vasculitis often associated with underlying hematologic, infectious, or autoimmune disorders. It typically presents as violaceous to brown papules, plaques, or nodules symmetrically distributed on the extensor surfaces of the extremities. Here, we report an atypical presentation of EED in a 55-year-old man, who presented with a 10-year history of bilateral verrucous plaques on the extensor extremities and soles. Histopathology demonstrated leukocytoclastic vasculitis and dermal fibrosis consistent with EED. All laboratory investigations for associated systemic disease were unremarkable except for immunoelectrophoresis, which was not conducted. Treatment with dapsone 100 mg daily, topical 5% salicylic acid, and intralesional triamcinolone acetonide resulted in initial improvement; however, adequate assessment of long-term treatment response was limited by the patient's loss to follow-up.