case_images: PMC11719440_01
case_images: Diffuse flesh-colored and erythematous excoriated papules and nodules on the back and upper extremity after discontinuing methotrexate treatment.
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case_images: Physical examination revealed dozens of flesh-colored to erythematous excoriated papules and subcutaneous nodules involving the abdomen, back, and eventually the upper and lower extremities (Figure 1).
case_images: A skin biopsy showing (a) unremarkable epidermis, superficial and deep perivascular and interstitial lymphohistiocytic infiltrate with rare eosinophils within the dermis, 4x magnification. (b) Colloidal iron stain highlighting dermal mucin, perivascular and interstitial lymphohistiocytic infiltrate within the mid-reticular dermis, 10x magnification. (c) Increased number of fibroblasts within the collagen bundles and interstitial mucin, 20x magnification.
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case_images: Repeated trunk and extremity biopsies revealed similar findings of superficial and deep perivascular and interstitial lymphohistiocytic infiltrate (Figure 2(a)), and increased fibroblasts and collagen bundles with interstitial dermal mucin deposition confirmed with colloidal iron stain (Figure 2(b) and (c)).
case_images: Scant erythematous excoriated papules and nodules on the back and upper extremity after 3 months of treatment with hydroxychloroquine.
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case_images: After 3 months of treatment, she reported a reduction in pruritus, decrease in the formation of new papules/nodules, and gradual resolution of existing lesions (Figure 3).