A 59-year-old white woman was referred for dermatologic consultation with a tentative diagnosis of petechiae of undetermined origin. The patient had been under psychiatric treatment for several years. As part of her mental state she remained mute, refusing to answer any questions. A history, therefore, was not obtainable.
At the time of the initial examination of this obese woman there were noted on the abdomen 12 to 15 round lesions which were violaceous in color and measured 2 to 8 mm. in diameter (Fig. 1). The lesions were atrophic and slightly depressed. Palpation of the skin of the abdomen revealed the presence of numerous scattered small firm nodules that were intradermal as well as subdermal. Many of the nodules were not in any way associated with the visible lesions. Because the lesions were not truly petechial in nature, and since the lesions did not fit a pattern associated