Reactive perforating collagenosis in end stage renal disease: Not all that itches is uremic pruritis!

A 51-year-old woman with a history of end-stage renal disease, on hemodialysis for 4years, hypertension and diabetes mellitus type II presented with an extremely itchy diffuse skin rash that she initially noticed two weeks prior to presentation. The itching was significant enough to impair her quality of life and she has tried applying various over the counter anti-itch creams without much relief. Examination of the skin was notable for diffusely scattered blackish hyperpigmented, dome-shaped, umbilicated papules, some coalescing into plaques on the trunk and extremities.