What are these asymptomatic nodules?

Asymptomatic bumps first erupted on a 55-year-old woman’s elbows 6 months earlier. She reports no history of trauma or insect bites.

What do you suspect?

A. Warts.

B. Psoriasis.

C. Lichen planus.

D. Granuloma annulare.

E. Xanthomas.

(Answer on next page.)

ANSWER—Case 2: Granuloma annulare

The indurated nodules are characteristic of granuloma annulare, D. This dermatosis primarily affects female patients, although most are younger than 16. The lesions typically erupt near joints.

Warts were ruled out because these lesions lacked the typical verrucous surface. The lesions of psoriasis are generally more scaly and pruritic. The flat-topped, polygonal, purplish papules of lichen planus are also itchy. Xanthomas are yellow to orange because of the presence of lipids.