A 53-year-old white woman initially presented with the sudden onset of a nonpruritic, slightly erythematous, nonspecific eruption over her upper chest area; diffuse symmetrical swelling and pitting edema of her hands and feet; and pain in the distal aspect of her extremities. She also complained of fatigue, but she had no mucous membrane involvement, visual disturbances, xanthelasma, or Raynaud phenomenon.
Her medical history was significant for obesity, plantar fibromatosis, hypertension, and a chronic seizure disorder. There was no family history of dermatologic disease. The results of a recent purified protein derivative test were negative, and a gynecologic examination performed within the last 6 months revealed no abnormalities. Physical examination revealed multiple discrete, smooth, red-brown papules and nodules measuring 0.7 to 2.0 cm in diameter over both elbows (Figure 1) and the nail folds (Figure 2). Musculoskeletal examination revealed marked edema of the hands and feet and flexion contractures of several proximal interphalangeal joints of both hands.
Touma SC, Kovach RF, Defazio J, Hornsby JAA. Red-Brown Papules and Nodules in a 53-Year-Old Woman. Arch Dermatol. 2001;137(9):1241-1246. doi: