A 46-year-old man with a history of systemic lupus erythematosus presented with a 6-month history of scaly, erythematous, tender nodules on his elbows and hands. Physical examination showed erythematous, umbilicated papules, with crusts on the elbows and the dorsa of the hands. Histopathologic examination demonstrated leukocytoclastic vasculitis with dense neutrophilic infiltrates and degenerated collagen, consistent with early palisaded neutrophilic and granulomatous dermatitis. The individual lesions were treated with intralesional glucocorticoid injections with some improvement.