After immigrating to the United States from El Salvador, a
16 year-old Hispanic female presented for evaluation of a
long-standing eruption. She developed hypopigmented
patches over her trunk and arms at the age of 5 that subsequently
became more extensive, dark, and pruritic. She was treated
for presumed sarcoidosis with topical steroids without response.
Our physical exam revealed extensive, indurated, dusky red
plaques on the extremities, breasts, buttocks, lower back, and
flanks with overlying scale and atrophy (Figure 1). Bulky, redundant
skin in intertriginous areas was noted (Figure 2).