History

This is a 42 year-old man
with a history of type I diabetes mellitus since age 10 with retinopathy, who presented in 2003 reporting an eruption on his neck and upper back. The
eruption had been asymptomatic but persistent for 6 months. This was originally
thought to represent folliculitis, and he was treated with benzoyl peroxide 10%
cleanser and one month of cephalexin without improvement. Over the last three years, the patient
reported progressive tightening of the skin in the shoulders and upper back.

Physical Examination

Diffuse erythema with
induration and thickening of the skin in the neck, shoulders, and upper back.
Small 2-3mm folliculocentric papules were present.

Laboratory Data

CBC within normal limits.
Fasting glucose 161, Hemoglobin A1C 8.2.

Treatment

The patient