A white woman in her 30s presented with a 2-month history of widespread erythematous, hyperkeratotic papules, and nodules with necrotic ulceration involving her face, trunk, and extremities (Figure, A and B). Her groin, buttocks, and oral mucosa were spared. In addition, there were hyperpigmented, ulcerated papules and nodules on her palms and soles. The eruption started as asymptomatic papules on her right forearm that spread progressively to the rest of her body and began to ulcerate. The patient did not have fevers, chills, or weight loss. She denied any history of sexually transmitted diseases, foreign travel, alcoholism, or immunodeficiency. Her last sexual encounter was with a reportedly monogamous partner 5 months prior. She did not seek medical care and received no treatments at the onset of her disease; however, she developed madarosis, low-grade fevers, and chills, prompting her to finally seek medical care. A biopsy specimen was taken from a nodule on her back (Figure, B and C).
Armstrong PA, Reichenberg JS, Diven DG, Gavino ACP. Diffuse Eruption of Necrotic Papules and Nodules. JAMA Dermatol. 2013;149(12):1429-1430. doi:10.1001/jamadermatol.2013.4717