Pruritic papules of the leg

A man, aged 52 years, presented with a two- to three-week history of pruritic papular eruption involving the right leg. His medical history included type 2 diabetes, managed with metformin and dapagliflozin; hypertension, for which he had been prescribed olmesartan/hydrochlorothiazide; and depression, which was treated with mirtazapine. He had no known allergies and no personal and family history of skin disorders. He reported working as a mechanic with no exposure to unusual irritants. He was a smoker (10 pack-years) and social alcohol consumer (two to three standard drinks per day on weekends). On examination he was systemically well with afebrile and skin phototype 2 (White). He had discrete brownish-red and pink papules on the anteromedial aspect of the right leg (Figure 1), with no involvement elsewhere. Central erosions encircled by scales were evident on some of the papules. There was no evidence of infection locally or systemically. There was no history of diabetic neuropathy, and the patient reported no pre-existing pruritus and no rubbing or scratching to the area prior to eruption. His blood test results were unremarkable and non-contributory.