May 1999

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History: This 92 year old black female presented to the Barnes/Jewish Hospital Dermatology Clinic with a three month history of an asymptomatic rash involving her face, chest, back, and dorsal hands (Figs A-C). She also reported three weeks of increasing dysphagia, dysphonia, and trouble walking.

Physical Examination: Erythematous to violaceous macules and patches involving her forehead, scalp, eyelids, malar cheeks, chest, back, and arms. Violaceous papules were noted on her dorsal hands. In addition, she had periorbital edema and periungal telangiectasias and purpura.

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