A 48-year-old woman visited the clinic with a 15-year history of a purplish red skin disorder on the left side of her neck. The lesion was asymptomatic and had slowly increased in size and thickness over the years. Because of her medical history of rheumatoid arthritis, she is on the following immunosuppressive medications: adalimumab, prednisone, azathioprine and hydroxychloroquine. On the left side of the neck a palm size area of multiple discretely arranged erythematous, violaceous coloured papules and plaques was seen (figure 1). An ultrasound showed that the lesion was restricted to the cutis.