June 2013







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).



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