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February 2007

Pruritic Patches on the Back and Papules on the Legs—Quiz Case

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Arch Dermatol. 2007;143(2):255-260. doi:10.1001/archderm.143.2.255-c

A 45-year-old woman presented with a 30-year history of an itchy eruption on her ankles and shins. She also noted a dark pruritic patch on her back that had appeared a few years after her leg lesions. Neither the leg nor the back lesions were induced by frequent rubbing or scratching. The patient described a similar eruption on the shins of her daughter and her mother.

Physical examination revealed numerous 1- to 3-mm, brown, closely set papules arranged in linear arrays and coalescing in some areas on the shins (Figure 1). There was an area of sparing over the course of a superficial vein on the right leg. Hyperpigmented, rippled patches were observed on the patient's back (Figure 2) and on her daughter's legs. Biopsy specimens were obtained from one of the patient's legs (Figure 3) and from her back (Figure 4).

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