An 84-year-old woman presented with a 6-month history ofmultiple painful cutaneous papulonodules on the buttocks andperianal area. She had underlying dementia and was bedridden.She had urine incontinence and encopresis for>10 years. Thepatient initially developed papules around the anus. She didnot undergo any systemic or topical treatment, and the papulesgradually enlarged to papulonodules after 6 months. Her familydid not report any history of topical skin contact. Physicalexamination showed many flat-topped erosive erythematouspapules and nodules on the perianal region (Figure 1). The rapidplasma reagin and Treponema pallidum hemagglutination testsyielded negative results. Bacterial culture did not yield anymicrobial growth. A skin biopsy showed psoriasiform acanthosiswith a moderate infiltrate of lymphoplasma cells and neutro-phils in the papillary and upper dermis. Koilocytic changesand fungal hyphae were not observed in the epidermis(Figure 2).
展开▼
