A 40-year-old Brazilian woman with a medical history of a subclinical hypothyroidism came to our clinic because of progressive distal numbness, weakness and polyarthralgia. She denied fever nor systemic symptomatology or any significant epidemiological event. Physical examination revealed multiple hypopigmented-hypoesthetic cutaneous patches, some of which had raised borders, mainly located on the face and back (Fig. 1A). In addition, she had severe skin ulcers and onychodystrophy, as well as joint stiffness and tenderness of the hands and feet (Fig.
