A cutaneous manifestation of a systemic disease
An African American man aged 52 years reported the development of new bumps on his knees and elbows over the previous two to three weeks. The patient had not seen a doctor for six months but had a history of diabetes that was treated with diet alone. Aside from some increased thirst and more frequent urination over the previous two months, he said he was otherwise feeling well.
The patient was 6′1″ in height and weighed 214 lb. He was normotensive. Darkly pigmented, firm and non-tender papules were evident on his knees and elbows (figures 1 and 2). There was no pruritus associated with these papules.