22 yo Italian male, complains about sensation of swelling at the right hand just woke up in the morning, for about two weeks. Fingers were itchy, and all started with 3-4 red, slightly elevated, itchy nodules of 1-2mm whose redness faded under pressure. They evolved to purple lesions to all distal phalanges of right fingers except the first, with pruritus enhanced in the morning. Symptoms started in April, and lasted for about a month, in the end the skin shrinked and exfoliation appeared. He took anti-histamines and applied a dex pomade with no improvements (only in pruritus). There was also a certain pain and tenderness of distal interphalangeal joints. Analogue symptoms complained in two toes of the right foot. No evidence of other skin lesions on the body, no aftosis. Negative for capillaroscopy, ANA, anti-ENA and RF, and other blood tests (mild asymptomatic neutropenia [1,7] probabily due to ibuprophen). No familiarity for autoimmune disorders, he is allergic to dust.
does it aggravate on touching cold water?
exclude Ssc ,MCTD n CRYOGLOBULINIMEA.
Investigate accordingiy.
Thnx.