Case presentation A 57-year-old woman presented to her primary care provider with an eight-year history of persistent skin lesions on her extremities. She described chronic, intensely pruritic eruptions accompanied by a compelling urge to scratch.
Despite repeated consultations and prolonged treatment courses with systemic antibiotics and topical corticosteroids, her symptoms persisted without significant improvement. Medical history Well-controlled type 2 diabetes mellitus, diagnosed 15 years ago Currently managed with metformin and daily NPH insulin Receives annual endocrinology follow-ups Physical examination (Cover Image) Multiple bilateral oval excoriations, approximately 1 cm in diameter, located on the bilateral arms, forearms, knees, and legs Lesions featured crusted areas with surrounding hypopigmented zones and scaling Excoriations were friable and bled minimally upon…
