A 58-year-old white woman with an 11-year history of type 1 diabetes mellitus presented in April 1995 with a complaint of flushing of the neck and the upper part of her trunk. She had had no antecedent febrile illness. The flushing resolved within a few days, but approximately 1 month later, the patient developed thickening and induration of the skin of the posterior section of her neck (Figure 1). She described restriction of neck movement, tenderness of the involved area, and a rash on the back of her neck. The results of her physical examination showed that she had several violaceous, indurated plaques involving the posterior section of her neck and the upper part of her back.