This presentation is a dermatology case in quiz form with a 4-point differential. The patient, a 44-year-old man admitted to Psychiatry Service for management of chronic psychosis, was noted to have multiple, circular, well-circumscribed violaceous cutaneous plaques resembling various dermatological conditions. This case underscores the importance of careful historical, clinical, and laboratory investigation to establish the correct diagnosis when evaluating skin lesions. Judicious laboratory testing may be helpful in excluding diseases such as syphilis and acquired immunodeficiency syndrome, which may mimic other dermatological conditions. Test your clinical acumen by deciding on a diagnosis. The correct answer is revealed in the discussion.
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