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Clinical photographs of bilateral upper extremities with violaceous papules and nodules. (A, C) Right hand and (B) left hand at initial clinical presentation. (D) Left hand, third digit, dorsum proximal interphalangeal (PIP) joint prepped and marked for biopsy. (E) Left hand, fifth digit, neutrophilic dermatosis ulcerated lesion on dorsum surface extending from metacarpophalangeal joint to the PIP joint.
