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JAMA Dermatology Clinicopathological Challenge
July 2014

Widespread Ulcerated and Vegetative Plaques With an Unusual Rhinophymatous Nose

Author Affiliations
  • 1Department of Dermatology, Amersham Hospital, Buckinghamshire National Health Service Trust, Amersham, England
  • 2Department of Dermatology, Churchill Hospital, Oxford University Hospitals National Health Service Trust, Oxford, England
JAMA Dermatol. 2014;150(7):773-774. doi:10.1001/jamadermatol.2013.9845

A tattoo artist in his 40s presented with a 5-month history of painful, oozing lesions over his trunk and limbs. A year earlier, he was a victim in an armed robbery and was shot in the right thigh. He reported that he has had problems with widespread abscess formation since then. His only medical history is of long-standing fulminant rhinophyma. He is a smoker but drinks minimal alcohol. On examination, he had multiple ulcerative and vegetative plaques with several pustules on his scalp, arms, groin, legs, and back (Figure, A). He also had a marked rhinophymatous nose, which was inflamed and ulcerated superiorly (Figure, B). There was no mucosal involvement and no lymphadenopathy, and he was apyrexial.

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