Inflammatory plaque with peripheral nodules: A new specific finding of cutaneous polyarteritis nodosa

Cutaneous polyarteritis nodosa commonly affects the distal lower limbs, presenting as nodules, ulcers, and livedo reticularis. We report five cases to illustrate a new specific presentation of cutaneous polyarteritis nodosa on the trunk or proximal extremities. In the acute stage, lesions were tende...

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Bibliographic Details
Published in:Journal of the American Academy of Dermatology 2009-02, Vol.60 (2), p.320-325
Main Authors: Chan, Po-Tak, MRCP, Ishiko, Akira, MD, PhD, Wada, Naoko, MD, Yamamoto, Nao, MD, Amagai, Masayuki, MD, PhD
Format: Article
Language:English
Subjects:
Adult
Biological and medical sciences
Biopsy
Dermatitis - etiology
Dermatitis - immunology
Dermatitis - pathology
Dermatology
Female
Humans
Lymphocytes - pathology
Male
Medical sciences
Middle Aged
Neutrophils - pathology
Polyarteritis Nodosa - complications
Polyarteritis Nodosa - immunology
Polyarteritis Nodosa - pathology
Sarcoidosis. Granulomatous diseases of unproved etiology. Connective tissue diseases. Elastic tissue diseases. Vasculitis
Skin - immunology
Skin - pathology
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Summary:Cutaneous polyarteritis nodosa commonly affects the distal lower limbs, presenting as nodules, ulcers, and livedo reticularis. We report five cases to illustrate a new specific presentation of cutaneous polyarteritis nodosa on the trunk or proximal extremities. In the acute stage, lesions were tender erythematous plaques. On palpation, 1- to 2-cm diameter subcutaneous nodules were found along the periphery. The lesions responded to dapsone, aspirin, nonsteroidal antiinflammatory drugs, or systemic steroids and healed with postinflammatory hyperpigmentation. Systemic polyarteritis nodosa did not develop in any patient after a follow-up time ranging from 9 months to 9 years. The presence of small nodules at the periphery of an inflammatory plaque was a useful clinical clue, because this prompted us to suspect cutaneous polyarteritis nodosa when we encountered similar cases later, which could be confirmed histologically. In conclusion, cutaneous polyarteritis nodosa can present as inflammatory plaques on the trunk and proximal extremities, and the presence of peripheral nodules around these plaques constitutes a useful clinical clue to its diagnosis.
ISSN:0190-9622
1097-6787
DOI:10.1016/j.jaad.2008.08.042