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JAMA Dermatology Clinicopathological Challenge
August 2014

An Unusual Follicular Eruption in a Young Adult With New-Onset Type I Diabetes Mellitus

Author Affiliations
  • 1University of Utah, Salt Lake City
JAMA Dermatol. 2014;150(8):891-892. doi:10.1001/jamadermatol.2013.10421

A man in his late 20s with new-onset type I diabetes mellitus (DM) was admitted for treatment of a gluteal abscess; management of diabetic ketoacidosis; and evaluation of diffuse, violaceous, follicular, scaly papules on the extensor surfaces of the bilateral upper and lower extremities (Figure, A and B). Examination of the skin also revealed palmoplantar keratoderma, as well as fissuring of the oral commissures. The skin lesions had begun 2 months previously and were not associated with visual changes, gastrointestinal tract manifestations, illicit drug use, foreign travel, recent illness, or constitutional symptoms. The patient had no notable medical history and denied a family history of DM, celiac disease, or chronic skin diseases. Punch biopsies of the upper and lower extremities were performed, and the specimens were stained with hematoxylin-eosin (Figure, C) and Verhoeff Van Gieson stain (Figure, D).

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