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January 2009

Acral Atrophic Papules, Petechia, and Patches of Alopecia—Quiz Case

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Arch Dermatol. 2009;145(1):77-82. doi:10.1001/archdermatol.2008.557-a

A 49-year-old white man presented with a 5-year history of a slowly progressive pruritic rash on both of his feet and hands. He denied any blistering, erosions, or ulcerative changes. Patch testing with the TRUE test revealed a positive reaction only to neomycin.

Physical examination revealed coalescing groups of atrophic white papules, some of which had a stellate shape, on an erythematous mildly fibrotic base and scattered pinpoint petechiae (Figure 1). There were patches of alopecia on the lower part of the legs and arms. Biopsy specimens from the right ankle (Figure 2 and Figure 3) and the arch of the left foot were obtained for histologic analysis.

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