A man in his 20s presented with painful, red, raised lesions on the right and left hands that first appeared 20 and 10 days prior to examination, respectively. Detailed medical history revealed that he had been working part-time at a cattle farm milking cows over the previous 2 months. He had no significant medical history or any recent drug intake.

On examination, there was a targetoid, yellow nodule with a peripheral rim of erythema overlying the dorsal aspect of first metacarpophalangeal joint of the left hand. The dorsum of the right hand over the first web space showed an irregular yellowish plaque with central erosion and crusting (Figure). There was no local lymphadenopathy, and systemic examination was unremarkable.

20多岁的一名男子右手和左手分别出现疼痛，红色和凸起的病变，分别在检查前20天和10天首次出现。详细的病史显示，在过去的两个月中，他一直在一家奶牛场做兼职工作。他没有明显的病史或近期有任何药物摄入。

检查时，有一个目标样的黄色结节，周围有红斑边缘，覆盖在左手第一掌指关节的背面。右手在第一个腹腔上方的背部呈不规则的淡黄色斑块，具有中心侵蚀和结ting现象（图）。没有局部淋巴结肿大，全身检查无异常。