A case of pustular
vasculitis of the hands with evidence of systemic involvement is described. A 64-year-old woman presented with a 2-day history of large, tense
bullae arranged symmetrically over the dorsum of the three radial digits and extending on to the radial aspect of the dorsum of each hand. The
bullae caused some discomfort and prevented normal use of her hands. There was no response to
antibiotic therapy initiated prior to referral to hospital. Initial investigations revealed a raised white cell count with a neutrophilia, a raised erythrocyte sedimentation rate and a raised
C-reactive protein. Abnormalities of liver function were detected. Aspirates from the
bullae and blood cultures were sterile. The histology of debrided tissue demonstrated a florid neutrophilic dermal infiltrate with many blood vessels associated with prominent
fibrin. A diagnosis of pustular
vasculitis of the hands was made. The
bullae were surgically debrided and treatment with oral
corticosteroids was started. Two days after commencement of oral
prednisolone, a crusted pustule appeared on her upper cutaneous lip. There was rapid resolution of both the
vasculitis of the hands and the pustule on her upper lip following an increase in the dose of oral
prednisolone. The patient was discharged on the seventeenth day following admission.