LAUSR

A 71-year old white man presented with a 2-month history of bilateral forearm ulceration, which was managed with dressings by his primary care practitioner. On direct questioning, he described ‘bumps’ forming under the skin, which would then ‘crust over and break down’. He had a history of bronchiectasis and chronic obstructive pulmonary disease requiring home oxygen. He had undergone successful fullthickness forearm skin grafts 10 months earlier for bilateral necrotic cellulitis. He was on a number of regular medications, which included prednisolone 15 mg daily, which he had been taking for many years. On physical examination, painful superficial ulceration was seen, affecting both forearms and extending onto the dorsal hand. The ulcers were noninflammatory and did not have an undermined edge (Fig. 1). Proximal to both elbows were three nodules, one of which was ulcerated. An incisional biopsy was taken from one of these.