Giane is a 63-year-old farmer who presents with a longstanding history of itchy hyperpigmented lesions on her legs.

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<p>Giane is a 63-year-old farmer who presents with a longstanding history of itchy hyperpigmented lesions on her legs.</p><p>These have been gradually progressing over about 10 years.</p><p>She has been using regular antihistamines and over-the-counter topical steroids to manage the itch, but these are no longer effective.</p><p>She is otherwise well and takes no regular medications</p><p> On examination, there are coalesced, papulonodular lesions on both legs (pictured). Examination is otherwise unremarkable.</p><p>Biopsies were sent, and histopathology revealed amorphous eosinophilic deposits in the papillary dermis that stained positive with Congo red.</p>

Dr Kate Kelso is a GP and medical editor at Australian Doctor.