Clinical Pearls: Ulcers on the Fingers

History of Present Illness. A 68-year-old woman presents to the ED for evaluation of ulcers on her left thumb and right index finger that appeared after minor trauma. The lesions began as tender erythematous nodules, which progressed and coalesced to pustules. The pustules gradually became more erythematous and began to ulcerate. A dusky hue developed around the margins of the ulcers. This process occurred over a ten-day period. The patient states she had a similar ulcerative process on the buttock and upper thigh region. Treatment at that time included surgical resection of the lesions, which resulted in spreading of the lesions. Subsequently, she was evaluated by a dermatologist and started on oral corticosteroids. The ulcerations slowly resolved, leaving her with large hypertrophic reticulated scars. She denies chemical exposure or arthropod envenomation. She denies diarrhea, bloody stool, fevers, headaches, and joint pain.