Chronic violaceous plaques on the arm

Abstract

A 45-year-old man originally from Pakistan presented with a 1year history of two increasingly raised and nodular plaques on his left arm, arising from areas of hyperpigmentation he reports were present from birth. He habitually scratched the lesions. He had no relevant past medical or family history and denied contact with animals, fish tanks, or recent travel abroad. He was systemically well. Physical examination revealed hyperkeratotic violaceous plaques on the left wrist and left medial elbow (Figure 1a-c). There was no regional lymphadenopathy. Blood tests showed normal full blood count, renal, liver, and bone profiles, and hepatitis B, C, HIV, and TB QuantiFERON were negative. A chest x-ray was unremarkable.