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Edema of the Hands: A Photo Essay

Edema of the Hands: A Photo Essay

The violaceous, nonpruritic eruptions seen here on the hand of a 62-year old man appeared 2 weeks earlier and affected the arms and legs as well. Hemorrhagic bullae and targetoid lesions are also seen. Punch biopsy of the bullae reveals a mixed, predominantly neutrophilic, perivascular infiltrate obliterating vessel walls, with fibrinoid necrosis, leukocytoclasis, erythrocyte extravasation, and overlying epidermal necrosis. These findings support the diagnosis of acute leukocytoclastic vasculitis.

Leukocytoclastic vasculitis
Courtesy of S Shane Rabin, BS, Jacob Dudelzak, MD, Jeffrey R. Lee, MD, and Daniel Sheehan, MD.

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