A 71-year-old white man with a history of skin cancer and hyperlipidemia presented with papules on his right knee and left anterior thigh and a patch of erythema and scaling on his left calf. Some improvement followed 3 weeks of triamcinolone 0.1% cream, but on reexamination he had dramatic livedo reticularis on his lower extremities as well as diffuse pink papules on background livedo of the lower trunk. He had noticed increasing fatigue, but otherwise felt well. What's your diagnosis?
Gerald G. Briggs, B.Pharm., pharmacist clinical specialist, Women's Pavilion at Miller Children's Hospital, Long Beach, Calif. Source on drug safety in pregnant and nursing women. Reported no conflict of interest.
Photos courtesy Dr. Adrian Guevara, Dr. A. Neil Crowson, Dr. Earl Bachenburg, Dr. Lawrence R. Johnson, Dr. Raymond Cornelison