Acute Pustular Eruption on the Hands.

A 56-year-old woman was referred to the dermatology department for a painful acral pustular eruption of 6 days’ duration. Her medical history was otherwise unremarkable. Physical examination revealed multiple pustules on the hands with large blisters on an erythematous base and painful surface ulceration (top). Papulonodular infiltrated lesions also were observed on the dorsal aspect of the hands (bottom). There were no additional systemic symptoms. Routine laboratory tests showed hyperleukocytosis at 17.9 × 10 3 /mm 3 (reference range, 4-10 × 10 3 /mm 3 ) with neutrophils at 12.3 × 10 3 /mm 3 (1.8-7.5 × 10 3 /mm 3 ) and elevated C-reactive protein at 67 mg/L ( < 5 mg/L). Screening for hematologic neoplasms, solid tumors, and inflammatory bowel disease was negative. An incisional biopsy was performed on a pustule on the palm of the left hand.