An unusual tender eruption

Abstract

A 53‐year‐old Caucasian female presented with a 3‐week history of multiple, raised, tender, erythematous papules and plaques on her trunk and upper limbs (Fig. 1). Some lesions had resolved to leave hyperpigmentation. Her general practitioner had treated her initially with chlorpheniramine followed by a course of phenoxymethyl penicillin with no effect. Following this she received prednisolone 30 mg OD for 1 week. This caused resolution of the lesions, but they recurred after the corticosteroids were stopped. The patient was otherwise fit and well with no other symptoms. She occasionally took acetaminophen for headaches but had not taken any for over a month. She was on no other medication. ... Full blood count, urea and electrolytes, liver function tests, and autoantibody screen were normal with the exception of an elevated neutrophil count (12.10 × 109/L). A lesional skin biopsy showed a deep dermal infiltrate concentrated around the eccrine sweat glands (Fig. 2a). This comprised predominantly neutrophils, and was associated with necrosis of the secretory gland epithelium (Fig. 2b).