Papulopustular eruptions of bilateral soles with facial erythematous papuloplaques in a 44-year-old female

A 44-year-old female suffered from chronic recurrent papules, vesicles and pustules on bilateral soles and heels for more than 1 year. It was associated with painful and itchy sensation. She had been treated as having pompholyx at a local hospital. The lesions improved partially but soon flared up after discontinuing the treatment. This time, she suffered from erythematous papuloplaques on bilateral cheeks and forehead with itchy sensation and mild tenderness for 4 months (Figure 1). Laboratory examination revealed eosinophilia (absolute eosinophil count: 1.310 ̃ 109/L; normal range: 0.050–0.350 ̃ 109/L). Immunoglobulin E level and antinuclear antibody were both within normal range and no parasite was found on stool examination. After the patient gave informed consent, she received biopsy at both facial and sole lesions. The facial lesion showed many eosinophils infiltrating to the pilosebaceous units in the dermis. Heavy mononuclear cell and eosinophil infiltration in the dermis were also noted (Figures 2A and 2B). The sole lesion showed mild parakeratosis, marked acanthosis, exocytosis, many epidermal pustules (subcorneal or intraepidermal), and mononuclear cells with neutrophils and eosinophils in the dermis. Some eosinophils were also found in epidermal pustules (Figures 3A and 3B).