Eleni Dimitra Bednar

A 66-year-old man was referred to our dermatology clinic for a 6-year history of a progressive pruritic rash, refractory to prescribed treatments. On examination, he had widespread follicular papules with 90% body surface involvement, nontender inguinal lymphadenopathy, and leonine facies (Figure 1A). He had seen 2 dermatologists who had performed skin biopsies; these were nondiagnostic but suggestive of follicular dermatitis, spongiotic pityrosporum folliculitis, or arthropod reaction.