A young woman presented in mid-November with a 1-month history of painful lesions on several toes. Results from a full review of systems were otherwise negative for disease. She denied any previous health problems, antecedent toe trauma, or illicit drug use. She denied any history of similar lesions. She was unemployed and had walked to her appointment. Her only medication was Depo-Provera for contraception. Physical examination revealed tender, dusky violaceous to pink confluent nonblanching macules studded with a few small, scaly papules on the volar surfaces of the bilateral great toes, right third toe, and left fifth toe (Figure, A). No similar lesions were noted on the hands or other skin sites. A punch biopsy specimen was obtained (Figure, B and C).
Mireku KA, Glover MHB, Davis L. Tender Macules and Papules on the Toes. JAMA Dermatol. 2014;150(3):329-330. doi:10.1001/jamadermatol.2013.6717