Snapshot A 36-year-old woman presents to her primary care physician due to intense pruritic lesions affecting her ankles and wrists. She reports that this has never happened before. Medical history is significant for prior hospitalization for sepsis secondary to methicillin-resistant staphylococcus aureus (MRSA) in the setting of intravenous drug use. Her only medication is methadone and she does not have any allergies. On physical examination, there are polygonal violaceous papules affecting the ankles and volar surfaces of the wrists. Upon closer inspection of the lesions there are Wickham’s striae. Introduction An uncommon, pruritic, inflammatory lesion most commonly involving wrists, ankles, mucosa login to view 7 more bullets Associated conditions login to view 1 more bullet Epidemiology Affects women > men Presentation Symptoms login to view 1 more bullet Physical exam login to view 9 more bullets Evaluation Skin biopsy login to view 1 more bullet Differential Psoriasis Papular eczema Discoid lupus (if scarring alopecia) Treatment Medical treatment login to view 2 more bullets Complications < 5% of cases of oral lesions progress to squamous cell carcinoma Prognosis Course is variable and unpredictable