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May 1994

Multiple Hyperpigmented Nodules

Author Affiliations

Wayne State University School of Medicine, Detroit, Mich

Arch Dermatol. 1994;130(5):653-654. doi:10.1001/archderm.1994.01690050121021

REPORT OF A CASE  A 38-year-old black woman was referred by her rheumatologist for evaluation of multiple hyperpigmented nodules over her arms, legs, and torso. She had a long history of cold hands and feet on exposure to cold. At age 22 years, nightly fevers, headaches, symmetrical polyarthritis, pleuritic chest pain, and erythematous plaques developed over her elbows and forearms. A chest roentgenogram was normal, but laboratory studies revealed a positive antinuclear antibody (ANA) titer (1:1280, speckled pattern). She received treatment with prednisone, hydroxychloroquine, and azathioprine. Her lesions improved; however, 40 to 50 hyperpigmented, often pruritic nodules developed over her torso and extremities. Azathioprine was discontinued 3 years later, but several new nodules developed yearly.The skin examination revealed atrophic scars (0.5 to 6 cm) with hypopigmented centers and hyperpigmented borders over the cheeks, torso, and all extremities (Figure 1). Scarring alopecia was absent, but pterygium unguium inversus was noted

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