Approximately one year ago, a 35-year-old African-American woman developed an eruption of approximately 10 papules (ranging in diameter from 3-25 mm) on each leg. The lesions were asymptomatic and did not bother her. Mild pruritus was directly associated with the lesions. She had not sought any previous treatment or used any OTC therapies. The woman’s medical history was significant for end-stage renal disease (ESRD). She had been receiving hemodialysis for the past five years. She also had diabetes, for which she took insulin.


A 15-year-old African-American female presented with approximately 20 papules on her arms and legs. The asymptomatic, 5- to 10-mm lesions had first appeared a few months earlier. No vigorous scrubbing or OTC medications had been attempted. Her medical history was significant for elevated renal function tests, arthralgias, and myalgia. She also complained of fatigue. Serologies were notable for an antinuclear antibody (ANA) titer of 1:1,280 and positive titers for anti-double-stranded DNA and anti-Smith antibodies.

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