Extremely pruritic ­hyperkeratotic papules

A black man, aged 55 years, presented with a 10-year history of a very itchy rash on both lower legs. He admitted to scratching and reported that several courses of prednisone had provided no relief. Seasonal allergies and asthma as an infant were his only medical issues.

No cardiac, GI or other skin problems were detected. The man works as ...