Pruritus and Chronic Papular Dermatitis in an Ethiopian Man

REPORT OF A CASE A 31-year-old Ethiopian man was seen because of the exacerbation of pruritus and a papular rash that had been present for several years. His relatives were not affected. Examination showed dry skin with scaling and areas of lichenification mainly on the lower extremities. A diffuse papular eruption was seen on the extremities and lower part of the trunk (Figure 1). Mild generalized lymphadenopathy was also present. Ophthalmologic examination revealed several pigmented lesions on both conjunctivae. A complete blood cell count showed prominent eosinophilia (0.30) without leukocytosis. The results of blood biochemical analysis were normal. There was a pronounced elevation of the IgE level and a milder elevation of the IgG and IgM levels. Serologic tests were negative for human immunodeficiency virus and syphilis. Biopsy specimens from papular lesions on the gluteal area are shown in Figure 2 and Figure 3.What is your diagnosis?