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An 84-year-old woman presented with a 6-month history of multiple painful cutaneous papulonodules on the buttocks and perianal area. She had underlying dementia and was bedridden. She had urine incontinence and encopresis for> 10 years. The patient initially developed papules around the anus. She did not undergo any systemic or topical treatment, and the papules gradually enlarged to papulonodules after 6 months. Her family did not report any history of topical skin contact. Physical examination showed many flat-topped erosive erythematous papules and nodules on the perianal region (Figure 1). The rapid plasma reagin and Treponema pallidum hemagglutination tests yielded negative results. Bacterial culture did not yield any microbial growth. A skin biopsy showed psoriasiform acanthosis with a moderate infiltrate of lymphoplasma cells and neutrophils in the papillary and upper dermis. Koilocytic changes and fungal hyphae were not observed in the epidermis (Figure 2).

Multiple erythematous erosive papules and nodules on the perianal area of an 84-year-old bedridden woman