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History: The patient is 30 year old african-american female with a seven month history of a pruritic papular eruption on the face, trunk, and extremities . Lesions started on the upper extremities and gradually became generalized. The cutaneous eruption and pruritus began several months after hemodialysis. Her past medical history is remarkable for IDDM, hypertension and chronic renal failure.
Physical Examination: Cone-shaped hyperkeratotic brownish red
papules-nodules were present on the extensor surfaces of the extremities,
scalp, face and trunk (Figs. A-C). The lesions had a central keratotic plug
and were tender to palpation.
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