Skin biopsy from firm yellow-brown plaques over the knuckles and elbows of an HIV-positive man shows a dense neutrophilic infiltrate in the dermis without frank vasculitic necrosis. Longstanding lesions show marked dermal fibrosis with extracellular lipid deposition. Which drug is the classic first-line treatment for this condition?
- A Colchicine
- B Dapsone ✓
- C Hydroxychloroquine
- D Methotrexate
Correct answer: B. Dapsone
Explanation
The presentation describes erythema elevatum diutinum, a chronic fibrosing neutrophilic dermatosis classically affecting extensor surfaces over joints, strongly associated with HIV infection and streptococcal or paraproteinaemia-related triggers. Histology evolves from early perivascular neutrophilic infiltrates to late fibrosis with cholesterol crystal deposition, which distinguishes it from acute Sweet syndrome. Dapsone is the traditional first-line agent and produces rapid response, although established fibrotic plaques respond incompletely and may need excision.
Reference: Bolognia, Schaffer and Cerroni, Dermatology, 5th ed.
High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP
Written and medically reviewed by the StethoPrep medical team.