Dermatologic Look-Alikes Raised Itchy Nodules

RISHABH LOHRAY;TALIA NOORILY, MD

A 62-year-old Black man with a history of atopic dermatitis presents to the clinic with persistent itchy bumps on his arms, legs, and back. The patient reports that the bumps have been present for several years.The bumps are firm and he reports scratching them often. The patient has tried treating the itching with topical corticosteroids with minimal benefit. On physical examination, hyperpigmented hyperkeratotic papules and nodules are found on bilateral extensor forearms, shins, and upper back. Other than the skin condition, the patient is healthy, has no other chronic medical conditions, and takes no medication. No further testing, including biopsy, is performed.

A 45-year-old Black woman presents to the clinic with a 1-year history of bumps on her forearms and elbows. She describes the raised bumps as intensely itchy.The patient reports no other skin condition or similar lesions elsewhere on the body. She has been treating the spots with topical corticosteroid ointment (clobetasol propionate) with minimal benefit.The bumps are not painful. On physical examination, hyperpigmented and violaceous firm papules are scattered on the extensor surfaces of both forearms. A 4-mm punch biopsy is performed. Other than the itchy bumps, the patient does not have any chronic conditions and takes no medications.