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A young woman presented with an asymptomatic papule on her right heel that she noticed 2 weeks prior while traveling in Uganda. It initially had a black center that disappeared as the lesion grew. She was able to express purulent material, but the papule failed to resolve. The patient denied systemic symptoms and was otherwise well.
Physical examination revealed a circular hemorrhagic-crusted papule with a central crater (Figure, A). The surrounding skin had a slight yellowish discoloration. A shave biopsy was performed with complete excision of the lesion (Figure, B and C).
Wilmer EN, Telang GH, Bercovitch LG. A Hemorrhagic-Crusted Papule With a Central Crater on the Heel . JAMA Dermatol. 2013;149(10):1235-1236. doi:10.1001/jamadermatol.2013.424