Itchy papular and nodular skin lesions in chronic kidney disease patient

A 65-year-old man with a history of obesity, type 2 diabetes mellitus (DMT2) for more than 10 years, stage 3b chronic kidney disease (CKD) and hypertension was admitted to our internal medicine ward for face cellulitis. He also complained of a 4-month history of moderately to severely generalized itchy skin lesions (Fig. 1) that had gradually increased in number. Clinical complaints had no correlation with time of the day or activities made. During that period, he denied use of new pharmacies and there weren't similar symptoms in family members. Clinical examination revealed generalized umbilicated keratotic papules, some of them with brownish post-inflammatory hyperpigmentation, sparing mucous membranes, superior third of the trunk, scalp, face, palm and toes. Biochemical workup revealed elevation of inflammatory markers, urea 190 ( Fig. 1

Fig. 1Multiple brown and itchy papules of the trunk, some of them with umbilicated erosion.

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