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A 46-year-old female presents with an evolving eruption that developed on her right hand and spread to her forearm over the past several weeks. She is an immunocompetent commercial landscaper who lives in Brazil, and she does not recall any specific injury. She is regularly exposed to toxic plants and sustains minor scratches and cuts at work. She also suspects that she could have experienced bug bites.

She appears well and is without systemic symptoms. On examination, you note smooth, scaly, and crusted, erythematous nodules in a linear configuration on her dorsal hand and forearm.

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

A 46-Year-Old with Evolving Sores on Her Hand and Arm
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