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JAMA Dermatology Clinicopathological Challenge
August 24, 2016

Clusters of Painful Blue Papules

Author Affiliations
  • 1Division of Vascular Surgery, Northwestern University Feinberg School of Medicine, Chicago, Illinois
  • 2Department of Dermatology, Northwestern University Feinberg School of Medicine, Chicago, Illinois

Copyright 2016 American Medical Association. All Rights Reserved. Applicable FARS/DFARS Restrictions Apply to Government Use.

JAMA Dermatol. Published online August 24, 2016. doi:10.1001/jamadermatol.2016.2746

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.

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