Erythema Elevatum Diutinum: A Rare Case Wth Atypical Presentation

Erythema elevatum diutinum (EED) is an uncommon, chronic vascular dermatosis characterized by plaques, nodules, and violaceous papules, typically affecting the extensor regions of the arms and legs. Although the etiology remains unclear, associations with autoimmune disorders, infections, and malignancies have been proposed. This case report presents a 56-year-old woman, non-diabetic, with an atypical presentation of EED, featuring painful lesions in contrast to the usual painless manifestations. The patient initially presented with painless nodules two years prior, which later became painful, involving multiple sites such as the hands, feet, knees, and back. Diagnostic evaluations, including histopathological examination, confirmed EED. The atypical pain prompted further investigations, ruling out underlying systemic conditions like arthritis or myositis. The treatment consisted of surgically removing the lesions and applying split-thickness skin grafts (SSG) to alleviate persistent symptoms and enhance quality of life. The case underscores the diagnostic challenges posed by atypical EED presentations, such as pain, and highlights the importance of a multimodal approach, including surgical intervention when medical therapy proves insufficient. The purpose of this report is to highlight the range of clinical manifestations in EED and the necessity of personalized treatment strategies to manage unusual symptoms effectively.