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JAMA Dermatology Clinicopathological Challenge
January 2016

Disseminated Red Violaceous Papulonodular Lesions

Author Affiliations
  • 1Internal Medicine Department, Faculty of Medicine, University of Concepción, Chile
  • 2medical student at Faculty of Medicine, University of Concepción, Chile
JAMA Dermatol. 2016;152(1):83-84. doi:10.1001/jamadermatol.2015.3949

A woman in her 40s presented to the dermatology clinic with a 6-month history of a generalized, asymptomatic, purplish-red papulonodular eruption. She reported that it began on her lower back and spread to her limbs during the next few weeks. She denied any systemic symptoms. Her medical history was significant for addiction to freebase cocaine and volatile solvents during her adolescence, for which she had received adequate treatment. She was not taking any medication at the time of consultation. There was no history of previous eruptions. Physical examination revealed numerous 10- to 25-mm red violaceous, nontender, rubbery nodules and papules together with brownish-red patches, all of which had some degree of scaling and a tendency to coalesce. The lesions were distributed across her face, trunk, and upper and lower limbs bilaterally (Figure, A and B). Palms, soles, scalp, genitalia, and mucosal surfaces were spared. Enlargement of lymph nodes and hepatosplenomegaly were absent. Her neurological and mental state examination showed no abnormalities. Biopsy specimens from the forearm and back were obtained (Figure, C and D).

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