A 15-year-old female, previously healthy, presents with a 3-week history of progressive lesions to bilateral hands. The lesions began as papular in appearance, although have progressed to include development of new papular lesions as well as mild ulceration of existing lesions. The lesions are non-painful (with the exception of significant pressure), have scant serous discharge, and are without surrounding erythema (Figure 1). Over the course of her illness, she received oral amoxicillin/clavulanate without a clinical response noted, and superficial bacterial wound cultures have remained without growth. She has been afebrile during this illness. On exam, she is resting in no acute distress. Her exam is benign apart from bilateral papuloulcerative lesions noted to her hands.
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