This healthy adolescent had a 1 year history of fatigue, intermittent fevers, myalgias, and joint pain and swelling associated with atrophic hypopigmented papules over her knuckles. A skin biopsy of a lesion on a knuckle and a subcutaneous nodule on her right forearm showed dermal mucinosis with overlying fibrosis and atrophy and telangiectasias but no evidence of vacuolar change. She also had mild narrowing of the distal fingers but no history of Raunaud phenomenon. Her clinical and histologic findings were consistent with features of several overlapping connective tissue disorders. Her joint symptoms and fatigue resolved with systemic steroids. An extensive laboratory evaluation was pending.
atrophic hypopigmented plaques with surrounding telangiectasias