This patient had diabetes and renal failure. She had developed these papules over a period of 12 months. They were itchy.This is Kyrle disease, or acquired perforating dermatosis.The characteristic papules have a keratotic plug made up of neutrophils with eliminated collagen and elastin which is being expelled through the epidermis. It is usually seen on the extensor surfaces of the lower extremities. The condition can completely disappear after renal transplantation.