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JAMA Dermatology Clinicopathological Challenge |

Erythematous Papules on the Forearms QUIZ

Shilpi Khetarpal, MD1; Ivanka Kovalyshyn, DO1,2; Anthony P. Fernandez, MD, PhD1,2
[+] Author Affiliations
1Department of Dermatology, Cleveland Clinic Foundation, Cleveland, Ohio
2Department of Pathology, Cleveland Clinic Foundation, Cleveland, Ohio
JAMA Dermatol. 2015;151(8):891-892. doi:10.1001/jamadermatol.2015.74.
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This case report describes a 72-year-old man with heart disease and a 2-month history of scaly erythematous papules on both forearms that did not improve with chlorhexidine or hydrocortisone. He had elevated creatinine and serum iodine but was otherwise asymptomatic. What is your diagnosis?

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A, Red, scaly papules on the patient's forearm. B, Punch biopsy specimen from the center of a papule on the forearm shows pseudoepitheliomatous hyperplasia, spongiosis with vesiculation, intraepidermal neutrophilic microabscesses, focal subepidermal bulla formation, and dermal infiltrate of neutrophils, lymphocytes, and histiocytes (hematoxylin-eosin, original magnification ×4).

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The American Medical Association is accredited by the Accreditation Council for Continuing Medical Education to provide continuing medical education for physicians. The AMA designates this journal-based CME activity for a maximum of 1 AMA PRA Category 1 CreditTM per course. Physicians should claim only the credit commensurate with the extent of their participation in the activity. Physicians who complete the CME course and score at least 80% correct on the quiz are eligible for AMA PRA Category 1 CreditTM.
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