This 55-year-old female presented to the dermatology clinic complaining of worsening generalized skin papules with pruritus for several months. The papules appeared at the trunk, behind the ears, dorsum of hands and nails. She recalled that these lesions first developed at early age as a teenager, with several exacerbations over the years. The symptoms worsened in the summer time, under the sun and heat conditions. She tried topical steroids improving symptoms at times, but the lesions never cleared.  She had no other complaints and a review of systems was unremarkable. The patient pointed out that her teenage daughter had begun to have similar lesions.

             Physical exam revealed erythematous, greasy-crusted papules on the central trunk, behind the ears and arms (Figure 1 and Figure 2). Nails on both hands showed longitudinal red and white lines extending from the base to the free edge of the nail plate with V-shaped notching (Figure 3).