https://orcid.org/0000-0001-5749-0109
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Conn McGrath, Thomas J Tull, Dorota Markiewicz, Natalie DeAnta, Eduardo Calonje, Clive Grattan, Eglantine Lebas, A widespread chronic pruritic varioliform ulcerating eruption, Clinical and Experimental Dermatology, Volume 50, Issue 5, May 2025, Pages 1063–1065, https://doi.org/10.1093/ced/llae539
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Clinical findings
A 70-year-old woman from Nepal was referred with a 7-year history of a pruritic eruption that had been recalcitrant to potent topical corticosteroids. She reported widespread, painful, pruritic and ulcerating lesions across her abdomen, chest, back and legs. There was no history of fever, chills, cough, dyspnoea, night sweats, weight loss or arthralgia. She had a background history of non-insulin-dependent diabetes, hyperlipidaemia and asthma, for which she took metformin, dapagliflozin, sitagliptin, atorvastatin and corticosteroid inhalers. Her medications had not changed in the 6 months prior to presentation. Her most recent travel history was a trip to Nepal in 2022. Physical examination revealed multiple dusky erythematous varioliform papules with central ulceration and overlying thick crust, which were largely monomorphic. They were present over the chest, abdomen, back, arms and upper thighs (Figures 1 and 2). Some areas had healed with scarring. There was no lymphadenopathy or organomegaly. Laboratory investigations indicated an elevated C-reactive protein of 26 mg L–1 (reference < 5 mg L–1) but normal full blood count, renal function and liver function tests.
