An elderly woman with painful annular erythematous plaques

A 75-year-old woman presented with a 2-week history of an enlarging, painful rash on the posterior aspects of her thighs. Her medical history was significant for chronic inflammatory arthritis and chronic kidney disease. She had been treated with low-dose prednisone for many years by her rheumatologist, and at the time of presentation was taking 7.5 mg daily. The physical examination revealed annular erythematous plaques with central hyperpigmentation on the posterior aspects of her thighs (Fig 1).

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