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November 1993

Tender Bluish Papules on the Trunk and Extremities

Author Affiliations

University of New Mexico, Albuquerque

Arch Dermatol. 1993;129(11):1507-1508. doi:10.1001/archderm.1993.01680320141019

REPORT OF A CASE  A 45-year-old white man presented with multiple bluish cutaneous lesions on his trunk and extremities. These were first noticed in his early 20s and gradually increased in size and number, some with satellites. Before being visible, new lesions were palpable subcutaneously. He denied spontaneous pain, but the lesions were painful on compression and would occasionally swell or bleed with trauma. History was noncontributory for blood loss or systemic symptoms other than occasional headaches. In adulthood, similar vascular lesions developed on his brother's thigh.Examination showed individual and grouped blue, serpentine, compressible "varicosities" (5 mm to 2 cm) over the patient's chest, forearms, and thighs (Figure 1). Moderate tenderness was present on palpation. Workup showed a normal complete blood cell count, gastrointestinal (GI) endoscopy, and cranial magnetic resonance imaging. The stool guaiac test was negative.An excisional biopsy specimen was obtained from a forearm lesion and is

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