A 50-year-old man presented with a 2-week history of a progressive eruption of firm, red-yellowish papules on his buttocks, back, and the extensor surfaces of his thighs and arms (Figure 1). At presentation, there were approximately 80 individual lesions, ranging in size from 2 to 4 mm in diameter. The scalp, face, mucous membranes, palms, and soles were spared. There was no lymphadenopathy. The patient complained of polydypsia (approximately 3.5 L/d), polyuria, memory loss, and dyspnea but no abdominal pain. His medical history was significant for moderate hyperlipidemia and a perioperative episode of insulin-dependent diabetes mellitus that had occurred 1 year earlier after a superficial parotidectomy for a pleomorphic adenoma. His diabetes was controlled with diet, and he was not taking any prescription medications at the time of admission. His family history was notable for ischemic heart disease and stroke at a relatively early age.
Otto AI, Horvath I, Feldmann J. Multiple Firm, Painless Erythematous Papules With a Yellowish Hue—Case. Arch Dermatol. 2005;141(12):1595-1600. doi:10.1001/archderm.141.12.1595-d