The patient is a 32 year old Hispanic woman with a 2 year history of pruritic nodules on her knees, right ankle and dorsum of right hand.Her health is good otherwise and she takes no medications by mouth. She denies kneeling, rubbing or manipulating the skin. Her primary physician has give her various topical steroids which were not effective.
O/E: There are a few hyperpigmented nodules in these areas. She has Type IV skin.
Clinical:
Lab: None
Diagnosis: Similar lesions have been seen after trauma from habitual pressure from kneeling, surfing, praying: but thepatient denies these.
I am not hopeful about impacting here. What thoughts do you have? Are any lab tests or biopsy indicated?
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