A 70-year-old man presented to the dermatology clinic for evaluation of a pruritic exanthem that began on his scalp and face and spread across most of his body over a 2-month period. The patient had no fever, night sweats, fatigue, recent unintentional weight loss, shortness of breath, chest pain, nausea, vomiting, or diarrhea. He reported no new prescription medications, over-the-counter drugs, or herbal supplements prior to the onset of the exanthem. He had no history of psoriasis, atopic dermatitis, or other skin disorder, and no recent viral or bacterial infection. On presentation, his temperature was 37.1 °C (98.7 °F); blood pressure, 128/86 mm Hg; heart rate, 110/min; and respiratory rate, 30/min. Physical examination revealed confluent salmon-colored plaques composed of folliculocentric scaly papules across his body with several patches of unaffected skin on his trunk. The patient had waxy, exfoliative scale on the volar aspect of his hands and feet and thickened, onycholytic nails. Severe ectropion prevented complete eyelid closure (Figure). He was referred to the emergency department, where laboratory testing revealed a normal complete blood cell count and normal lactate dehydrogenase level. The patient was admitted to the hospital and was treated with intravenous fluids and daily wet-wrap therapy with topical triamcinolone ointment (0.1%) applied to his trunk, arms, and legs, followed by a layer of warm, damp gauze and dry, cotton pajamas.