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A 52-year-old Hispanic man presented with diffuse violaceous, hyperkeratotic papules, as well as vascular-appearing, verrucous nodules and plaques on hislower extremities. The lesions had developed over the preceding 25 years, mainly on his legs, but also on his abdomen, buttocks, and arms. The leg lesionsbegan as erythematous to violaceous papules and enlarged into exophytic, verrucous nodules with frequent bleeding after minor trauma and chronic secondary bacterialimpetigo. Prior cryotherapy, shave excison, and KTP laser removal were unsuccessful in preventing recurrence of the leg lesions. The patient denied ocular problems,fever, paresthesias, and neurologic and cardiac abnormalities, but his medical history was significant for hypertension, gout, sleep apnea, and obesity.His family history revealed no family members with similar cutaneous lesions.
Physical examination revealed hundreds of 2- to 5-mm hyperkeratotic, violaceous papules on the abdomen, buttocks, and arms and diffuse 0.3- to4-cm verrucous, exophytic nodules and plaques on the lower extremities (Figure 1 and Figure 2). Serologic studies were performed, and multiple skin biopsy specimens were obtained (Figure 3),with bacterial, fungal, and mycobacterial cultures of tissue specimens.
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Country-Specific Mortality and Growth Failure in Infancy and Yound Children and Association With Material Stature
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