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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