A 29-year-old man with a new diagnosis of human immunodeficiency virus (HIV) and a recent CD4 lymphocyte count of 458 was seen in our dermatology clinic for skin changes that had started 3 months prior. He initially noticed a pruritic papule on his arm and then subsequently developed scaly patches on his arms, legs, and body, with later involvement of his palms and soles. He experienced extreme pruritus and was constantly scratching the areas. He also noted alopecia where he had scaly patches on his scalp. He also noticed new-onset knee pain. Physical examination revealed thin erythematous plaques, some with overlying silvery scale involving the scalp, face, arms, legs, and body (Figure 1). His palms and soles had thick, silvery-white hyperkeratotic scale overlying erythematous plaques, and multiple toenails had thickened nail plates with onycholysis. A punch biopsy from his right thigh was performed (Figure 2).