Derm Dx: Pruritic papules in a healthy 42-year-old woman

A 42-year-old Hispanic woman with no prior medical problems presents complaining of multiple pruritic papules and hyperpigmented spots on her arms, trunk and legs. The patient states that the pruritis is frequently worse at night, at times unbearable, but at other times the skin lesions are completely asymptomatic.

On physical exam the patient has multiple firm, small hyperpigmented to slightly ...