These wounds occurred when this 77-year-old woman fell when chasing her dog. Such wounds — a combination of ecchymoses and erosion caused by blunt and sheering forces on fragile skin— are common in the elderly, even after relatively mild trauma. Simple interventions will promote healing.
These widely scattered, dome-shaped pruritic inflammatory papules suggest insect bites. A biopsy showed mixed dermal infiltrate consisting of lymphocytes and eosinophils, consistent with an arthropod assault.