Itchy, bumpy, and scratch...

A 55-year-old woman complains of itchy, bumpy, and scratchy oval areas on both of her shins and on her back (Figure 1). She sought treatment after receiving no relief from conservative management, the patch on her back grew larger, and the itch persisted. Her medical history indicates that she has well-controlled hypertension treated with hydrochlorothiazide 12.5 mg and constipation treated with lubiprostone 8 micro gm. Her medical background includes a left complete knee replacement and a hysterectomy. Her family has no history of skin cancer. Laboratory testing and microscopy were done (Figure 2).