History: 31 yo WM presented with a two-year history of a rash that began on his nose and neck. A different appearing rash then appeared on his back one year later that spread to his chest and abdomen. He had been seen by two outside dermatologists who had placed him on minocycline for 2 months and a mild topical steroid, neither of which caused improvement.
Review of systems: pertinent for weight loss and temporal hair loss.
Past Medical History: cigarette smoking and illicit drug use
Family Hx: not significant
Physical Exam: On his nose (Fig. 1) was a ~2x2 cm violaceous, slightly scaly, thin plaque. On his neck were erythematous papules and depressed/atrophic scarring. On his back/chest/central abdomen were multiple discrete ~1-3 cm yellowish dermal and subcutaneous nodules (Figs. 2,3).
Laboratory findings: All labs were normal including BUN, Creatinine, WBC, Hct, AST, ALT, ANA, Anti-Sm, Anti RNP, HIV, RPR & SPEP.
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