A 58-year-old white man presented with a 2-year history of a rash consisting of multiple 2- to 5-mm, flesh-colored, firm papules on the posterior helixes of the ears, on the dorsal surface of the wrists and hands, and on the fourth and fifth fingers overlying the joints (Figure 1 [arrows]). His skin also showed background erythema caused by moderate actinic damage. He had a 5-year history of recurrent debilitating bouts of pain and swelling involving his wrists and hands, as well as episodes of morning stiffness of his hands, and a 88 pack-year history of smoking. He had no history of Raynaud phenomenon.
Petro A, Wegman PA, Su LD. Acral and Ear Papules and Arthritis—Quiz Case. Arch Dermatol. 2003;139(5):657-662. doi:10.1001/archderm.139.5.657-a