Secondary palmar crust in a 36-year-old cisgender man with HMPX, imaged at lesion day 11.
Located on the left palmar web between the thumb and first finger is a single 1-2-mm crust with light surrounding hyperpigmentation. Part of a secondary crop of lesions, this lesion developed on illness day 7, was briefly pruritic but nontender throughout its evolution, and was accompanied by the onset of numerous mildly tender and mildly pruritic lesions on the face, scalp, torso, genitals, and bilateral upper extremities.
His illness began as a single pustular lesion on the right fourth finger, followed by systemic symptoms (fever, chills, sweats, fatigue, myalgias, arthralgias, and back pain) on illness day 4.
There was no history of immunocompromising conditions or medications. This man was on Truvada for HIV pre-exposure prophylaxis.