History: A 12 year-old Caucasian male presented to the Washington University pediatric dermatology clinic complaining of nontender erythematous areas of skin on his fingers and toes of approximately 7 months duration. He stated the lesions would appear suddenly and then fade over a period of days to weeks. He was evaluated by rheumatology in May for complaints of redness and pain on his fingers and toes for a month. He had a normal CBC, ESR, ANA, and RF at that time.
Past Medical History: eczema, ADHD, allergic rhinitis
Allergies: No known drug allergies, but has a documented tree nut allergy
Medications: Methylphenidate, fexofenadine
Social History: No alcohol, smoking, or illicit drug use. Not sexually active.
Family History: Mother has history of Raynaud’s disease and Sjogrens
Physical Exam: Patient’s left 3rd finger dorsal DIP shows a non-tender erythematous plaque (Fig 1). The left 5th finger volar middle phalanx has a similar lesion (Fig 2). The Left 2nd toe has a 5mm erythematous papule along the proximal nail fold (Fig 3).
Click here for the Diagnosis.