Multiple Painful Skin-Colored Papules—Quiz Case

Abstract

A 54-year-old woman presented with a 2-year history of a mildly pruritic, golden-brown rash that first developed on her palms and progressed to her shins and soles. The patient’s medical history and medications were unremarkable. Physical examination revealed dusky, reddish-brown patches on her bilateral soles and reddishbrown patches with scattered red puncta on the dorsum of her feet, shins, and palms (Figure 1 and Figure 2). Laboratory test results showed no abnormalities for full blood cell count, double-stranded DNA, antinuclear antibody, serum protein electrophoresis, and erythrocyte sedimentation rate. A shave biopsy specimen was obtained (Figure 3). What is your diagnosis?