Pink papules on the fingers

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CASE #1
The patient was a 10-year-old child who complained of smooth pink papules that had been present on eight different joints of both hands for several months. The papules, which broke the normal skin lines, were not painful to direct or lateral pressure. No black dots were visible within the lesions. The patient had no signs of dermatomyositis and showed no muscle weakness. A superficial shave biopsy of the papules revealed hypergranulosis and a number of variably shaped inclusion bodies with marked condensation of keratohyalin granules. There was no evidence of an interface dermatitis or lymphocytic infiltrate.


CASE #2
An 8-year-old girl had pink-purple papules on her hand joints. For the past year, she had had a hand rash, periorbital edema, and muscle weakness. A lilac coloration and edema were observed around her eyes. Her creatine kinase was >2,000 units/L; an antinuclear antibody titer was unremarkable. She had known photosensitivity. There was no evidence of calcinosis cutis or cutaneous vasculitis. Her arms demonstrated mild persistent erythema. Muscle weakness was noted when she shrugged her shoulders and with other basic tests. A biopsy of the hand eruption revealed interface dermatitis, a lymphocytic infiltrate, and scant mucin.

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