A 47-year-old woman presented with multiple asymptomatic papules on her arms and back. She reported that the initial lesions had started 11 months earlier on the distal aspect of her upper extremities. Subsequently, many more lesions developed on her arms before lesions began to appear on her torso. Her personal and family histories were unremarkable. She complained of a 6-month history of diarrhea and a weight loss of 14.5 kg over the past 11 months. She attributed the weight loss to a pending divorce. The patient was 163 cm tall and weighed 36 kg.
Yag-Howard C, Shenefelt PD. Multiple Pink Papules With White, Depressed Centers. Arch Dermatol. 1998;134(2):231-236. doi: