October 2007





History: A 48-year-old African-American woman presented with an 18-month history of asymptomatic scaly hyperpigmented patches on her palms and soles. She also reported a 2-month history of an axillary rash. Previous treatment with triamcinolone 0.1% ointment and hydroquinone was unhelpful. Her past medical history was significant for chronic renal failure secondary to systemic lupus erythematosus (SLE); she was scheduled to undergo renal transplant the following month. Medications, family history and social history were non-contributory.

Physical exam: Significant for non-tender hyperpigmented nummular patches with minimal scaling on the palms and soles (Figure 1). Hyperpigmented papules and plaques were noted on the bilateral axillae and central back (Figure 2).

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