A 50-year-old Korean man presented with exophytic and deep-seated papules and nodules on his right forearm. He had been in close contact with defoliants during the Vietnam War in 1972. The lesions had developed since 1980. Some of the lesions had been excised 10 years earlier, but the lesions had recurred and had gradually increased in size and number.
On physical examination, the patient had a total of 7 lesions: a cluster of 4 nodules measuring 2 × 2 cm and a cluster of 3 papules measuring 0.5 × 0.5 cm (Figure 1and Figure 2). The lesions were irregular in shape, and some were exophytic, while others were primarily below the skin surface. Whitish foul-smelling material was expressed from one nodule; another nodule showed a central terminal hair.
Kim SE, Oh CW. Multiple Papules and Nodules on the Forearm—Quiz Case. Arch Dermatol. 2003;139(6):803-808. doi:10.1001/archderm.139.6.803-a