A 38-year-old morbidly obese man presents with a 1-month history of rash on the extensor surfaces of his hands, forearms, elbows, shoulders, flanks, and upper thighs. The rash is nonpruritic but is associated with burning pain. The patient has had no fevers, shortness of breath, recent viral syndromes, or recent travel. He has a history of pancreatitis several years prior, recent repair of a tibial fracture, ankle osteoarthritis, cholelithiasis, seizure disorder, and bipolar disorder. He has a family history of type 2 diabetes in his father and brother. His current medications include phenobarbital, levetiracetam, quetiapine, lorazepam, fluoxetine, tramadol, aspirin, celecoxib, and gabapentin, none of which were started in the past few months. Skin examination reveals hundreds of bright pink papules with central yellow hue distributed symmetrically over his dorsal hands, elbows, shoulders, and thighs (Figure 1). The remainder of the examination is unremarkable.
Melnychuk E, Perlmutter AW, Hossler E. A 38-Year-Old Man With Extensor Surface Papules. JAMA. 2015;313(1):83-84. doi:10.1001/jama.2014.15261