42 year-old man with tightening of neck and upper back

    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

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