Patient History: A 56-year-old man presented with multiple small asymptomatic whitish papules that had appeared 3 months earlier on both hands. The patient's history included systemic hypertension on treatment with valsartan, untreated hyperuricemia, dyslipidemia, and moderate alcohol consumption with findings on magnetic resonance imaging suggestive of chronic pancreatitis. Physical Examination: Physical examination showed numerous small (2-3mm) whitish papules on the palms and fingertips of both hands. The papules were hard and smooth and some of them were ulcerated (image attached).
Histology: A biopsy was performed of 1 of the lesions. Microscopy revealed a large nodular deposit of amorphous material containing acicular clefts in the dermis, surrounded by pseudopalisading histiocytes and a marked foreign body giant cell reaction. In close proximity to the main lesion, multiple,…
