A 43-year-old man presents to urgent care with a rash that he noticed a couple of days ago on his trunk. On exam, there is skin atrophy and multiple smooth papules and hypopigmented oval macules. Upon palpation of the lesions, you find that the examining finger “sinks” into a pit with distinct edges, like the ring of a hernia.

The patient is immunocompetent, and his medical history is unremarkable except for lichen planus. He patient appears well, denies systemic symptoms, and does not take any medications.

View the image and consider what your diagnosis and next steps would be. Resolution of the case is described on the next page.

Rash with Smooth Papules
Figure 1.
A 43-Year-Old with a New Rash on the Trunk
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