An 11-year-old girl presents with a cutaneous eruption localized to the bilateral lower extremities. The eruption first appeared 1 month before presentation, during the winter. The patient’s mother reports discrete bullae, which resolved before presentation. The child is well in all other respects. Physical examination reveals ill-defined hyperpigmented and reticulated patches on both of the anterior legs (Fig 1). Discrete hyperkeratotic nodules are present distally (Fig 2). The lesions are nonblanching and fixed. A punch biopsy sample of one of the hyperpigmented nodules on the left leg was sent for histopathologic examination and confirmed the diagnosis (Fig 3).

The clinical differential diagnosis of a mottled or reticulated eruption in a child primarily includes livedo reticularis, erythema ab igne (EAI), and erythema infectiosum. Because this patient was systemically well and the cutaneous changes presented in the winter months, we initially suspected EAI. The patient vehemently...

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