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A woman in her 30s presented with multiple discrete and clustered blue papules on her face and extremities. The lesions had been present since childhood, but the size of the lesions and the intensity of pain associated with them had recently increased with even light touch causing paroxysms of pain. The pain associated with these papules worsened as the day progressed, and she could not tolerate elastic compression due to excessive pain on compression. Her medical and family histories were unremarkable. Physical examination revealed multiple discrete and agminated blue papules on the face, arms, hands, and thighs with a cobblestoned appearance (Figure 1). On palpation, the papules were exquisitely tender and partially compressible. The patient underwent duplex ultrasonography of representative papules on the thigh, and a skin biopsy specimen of a papule on the thigh was obtained for histopathologic evaluation.
Yoon DY, Clark MA, Rodriguez HE. Clusters of Painful Blue Papules. JAMA Dermatol. Published online August 24, 2016. doi:10.1001/jamadermatol.2016.2746