A man in his 80s presented with an 18-month history of a pruritic, burning rash on both hands. No other skin lesions were present except actinic poikiloderma in sun-exposed areas. The broad areas of hardened skin with fibrotic nodules and joint contractures typical of NSF were not present. Previous treatment with a combination of clotrimazole and betamethasone dipropionate cream (Lotrisone) twice daily for 8 weeks and then clobetasol dipropionate cream, 0.05%, twice daily for 8 weeks failed to resolve the signs or symptoms. The patient’s medical history was significant for cervical spine disease, prostate carcinoma, hypothyroidism, varicella, and gallstones. He received multiple magnetic resonance imaging scans and was exposed to 20 mL of gadodiamide contrast dye (OmniScan; GE Healthcare) in August 2008, September 2008, January 2009, February 2010, and January 2011 (total, 100 mL). His medication regimen included aspirin, divalproex sodium, levothyroxine sodium, methocarbamol, a combination of naphazoline hydrochloride and pheniramine maleate, and omeprazole. Six erythematous annular plaques were present on the dorsal hands ranging from 0.5 to 2.0 cm in diameter. Fine papules were noted at the periphery and scaling was absent (Figure 1). The clinical differential diagnosis included granuloma annulare, annular elastolytic granuloma, and cutaneous sarcoidosis. A 6-mm punch biopsy specimen demonstrated discrete round and oval areas of eosinophilic, finely laminated, amorphous material surrounded by spindled fibrocytes, diagnostic of sclerotic bodies (Figure 2, A and B). Solitary cells with plump nuclei were present within the sclerotic bodies, resembling osteocytes within the bone matrix. In some areas, the amorphous material was centrally calcified, and in others it was completely calcified. No osteoma or cartilagenous tissue was identified. No basaloid cells of the type seen in pilomatricoma were present. A Masson trichrome stain revealed blue staining typical of the sclerotic bodies and Verhoeff–van Gieson stain revealed entrapped but intact elastic fibers within the sclerotic bodies (Figure 2, C). A panel of immunohistochemical stains, including CD34, CD68, factor XIIIa, CD99, vimentin, and S-100 protein, was performed. The spindled fibrocytes surrounding the sclerotic bodies stained positively with CD68 and factor XIIIa. The solitary cells within the sclerotic bodies as well as the variable number of stromal cells were highlighted by vimentin. The CD34 stained the blood vessels and scattered stromal cells. The S-100 protein and CD99 stains were negative in both the solitary cells within sclerotic bodies and the surrounding fibrocytes (Table). Intralesional injection of triamcinolone acetonide, 20 mg/mL (0.5-1.0 mL per plaque), monthly for 3 months led to complete resolution of symptoms and flattening of the GAPs.