Three young men developed multiple firm asymptomatic nodules confined to the shaft of the penis. Skin biopsies from all 3 cases showed prominent necrobiotic granulomas indistinguishable from granuloma annulare. One of the patients had repeated recurrent nodules confined to the penis which were removed surgically over a period of 20 months. This unusual, but benign, presentation of granuloma annulare has to be distinguished from other granulomatous and malignant processes which may present as penile nodules.

A 33-year-old woman with a background of thalassaemia major presented with a 3-month history of yellowish plaques on the back of her neck bilaterally and alterations in the texture of the skin in both axillae. Examination of these lesions showed yellowish cobblestone plaques and coalescing papules in both axillae. Pseudoxanthoma elasticum (PXE)-like lesions were confirmed histopathologically. PXE-like lesions in association with thalassaemia major are an uncommon occurrence. Due to the increase in the survival rate of thalassaemia major patients on treatment, the development of these lesions is likely to increase. The histopathological manifestation of these lesions mimics that of hereditary PXE and is associated with severe vascular complications. This case highlights the importance of recognising this rare disorder and the role dermatologists have in establishing the diagnosis and advising on appropriate screening for complications.

SUMMARY A 60-year-old man with destructive rheumatoid disease, multiple nodules, and vasculitis developed a facial rash with ulceration and scarring. Histology showed granulomatous vasculitis. The rash was rapidly controlled with oral corticosteroids. Granulomatous vasculitis has not previously been reported as causing this clinical picture in the absence of concomitant necrobiosis and palisading.