A 40-year-old woman with excoriated skin lesions.

A 40-year-old woman presents to the clinic with multiple excoriated lesions over her chest, arms, abdomen, and upper back (Figure 1, Figure 2). The lesions have been present for many years; a few of them show signs of recent bleeding. She denies any history of itching, insect bites, exposure to new medications or jewelry, allergies, recent change in medications, travel, or intravenous drug abuse. A review of systems finds no liver, kidney, or heart disease. On examination, we find multiple scattered, weeping, crusted ulcerations, hyperpigmented macules and papules, and atrophic scars in different stages of healing on the upper chest, arms, abdomen, and upper back.