REPORT OF A CASE
A 63-year-old white woman was referred to the dermatology clinic of the University of South Florida College of Medicine, Tampa, for a chronic eruption mainly involving the extensor aspects of her arms and legs. Past treatment included corticosteroids, topically and systemically, with only modest improvement. The patient also complained of arthritis. Physical examination revealed widespread involvement, particularly of the extensor surfaces, with reddish-purple papules and plaques. Many of the lesions were grouped in an annular or circinate pattern (Fig 1). Close inspection disclosed two distinctive findings: lesions of recent onset by history were soft and purpuric (Fig 2), while those of greater duration were firm and yellowish (Fig 3). Large plaques were notable over bony prominences, especially the elbows, knees, and interphalangeal joints. All laboratory studies, including electrolytes, complete blood cell count with differential cell count, and erythrocyte sedimentation rate, were within normal ranges.
Perez IR, Fenske NA. Extensive Purpuric and Yellowish Papules and Plaques With an Annular Configuration. Arch Dermatol. 1991;127(9):1402. doi:10.1001/archderm.1991.01680080139021