When a patient presents with six or more dermatofibromas, consider systemic lupus erythematosus in your differential. — Kathleen Haycraft, DNP, FNP/PNP-BC, DCNP, Hannibal, Mo.

These are letters from practitioners around the country who want to share their clinical problems and successes, observations and pearls with their colleagues. We invite you to participate. If you have a clinical pearl, submit it here.