Disseminated pruritic papules

A 60-year-old Arabic man with a medical history of diabetes mellitus was admitted to the hospital for an unprovoked deep vein thrombosis with pruritus, nonproductive cough, and abdominal pain. His pruritus had been ongoing over the preceding four months and he has developed diffuse erythematous to hyperpigmented papules with some having a central keratotic core and others with hemorrhagic crusting. He had minimal to no improvement in his pruritus on mid-potency topical corticosteroids in combination with antihistamines.