CASE


A 39-year-old female presented for evaluation of a rash on her legs. The patient stated that the rash, which was slightly pruritic and had been present for more than a year, had started out as just a few spots on her shins that increased with time (Figure 1). For the past 2 weeks, she had been treating her rash with a class 1 topical cortico­steroid but had seen no improvement. The patient was otherwise healthy and physically active.


On examination, multiple atrophic reddish to brown annular lesions with a distinctive hyperkeratotic border were noted on the lower extremities. Numerous lentigines on sun-exposed areas of her skin and uniform brown nevi on her back were also present. A shave biopsy was performed.



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