CASE
A 54-year-old female presented with a persistent rash on her right lower leg. The rash had been present for the past year, but she had not used any OTC topical medications. Aside from a mild itch at the site of the lesion, the patient reported no other symptoms. Her medical history was significant for diabetes mellitus. The patient said she took metformin, insulin (NovoLog), aspirin, and a multivitamin.
Physical examination revealed numerous atrophic pink and yellow waxy papules and plaques on the pretibial region of the right leg (Figure 1). The lesions appeared smooth, indurated, and annular in shape with moderately erythematous and blanchable surrounding tissue; 1+ pitting edema was seen in the right lower leg. Examination of the remaining skin was unremarkable except for the presence of skin tags on the posterior base of the neck. A 4-mm punch biopsy was performed.
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