A woman in her 60s presented with a 6-month history of itchy eruptions that initially started on the arms and then spread to involve the lower legs. The patient admitted to occasional burning sensation of new lesions. On review of systems, the patient denied fevers, fatigue, myalgias, arthritis, shortness of breath, oral ulcers, and recent infections. Clinical examination revealed several erythematous patches and plaques on the arms and lower legs, and nontender violaceous firm nodules on the elbows, wrist, ankle, interphalangeal, and metatarsophalangeal joints (Figure 1A and B). There was no lymphadenopathy present. A punch biopsy specimen from a plaque on the right forearm was obtained (Figure 1C and D).
Villanueva AR, Bradley L, Rodney I. Erythematous Plaques and Violaceous Nodules on Extensor Surfaces. JAMA Dermatol. 2016;152(3):331-332. doi:10.1001/jamadermatol.2015.4945