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Concentric targetoid scaly plaques in a patient with severe rheumatoid arthritis

A woman in her 60s with a history of severe rheumatoid arthritis and type 2 diabetes presented to the dermatology clinic for a 2-week history of a spreading pruritic and burning eruption on the lower extremities. She reported that it began as a single plaque on the left buttocks and subsequently spread to multiple plaques involving both legs. The patient denied any systemic symptoms including fevers or chills. For her rheumatoid arthritis, her treatment regimen included monthly abatacept infusions, daily prednisone, and celecoxib. Other daily medications include insulin, metformin, ramipril, aspirin, gabapentin, and pantoprazole. On clinical examination, there were concentric and targetoid red-brown thin 3–6 cm plaques with overlying scale on the posterior left upper thigh, the right medial thigh, and the right ankle (Fig 1). A 4-mm punch biopsy for histopathological examination and a biopsy for tissue culture were obtained.