A 55-year-old female presented for evaluation of 2 problems. She initially made the appointment for the flat, reddish-brown, asymptomatic plaques that had appeared on her arms and legs 4 months prior. In the last 2 days, she had also developed very itchy, red papules on her arms. She is otherwise healthy.
These flat, reddish-brown circular plaques are granuloma annulare, a benign asymptomatic condition more common in women. It runs a self-limited course and does not require treatment, which is fortunate, as it does not respond to any treatment in a consistent manner.
The 3 papules in a row are suggestive of bed bugs. A patient history confirmed recent exposure history due to her work with the homeless.