Images of Memorable Cases: Cases 126, 127 & 128 Acral skin lesions of three young adults with fever and painful joints of several days’ duration. 126, 127 & 128. Gonococcal dermatitis A characteristic eruption accompanying transient gonococcal bacteremia. The lesions are discrete, scanty, 1 mm to 2 cm in diameter, and typically appear on the distal parts of the extremities, often periarticular. They begin as erythematous macules and quickly become vesiculopustular or hemorrhagic. Occasionally, bullae develop. Mature lesions are elevated and slightly umbilicated and have a gray, necrotic center with an irregular violaceous border. Healing occurs in three to four days, with or without therapy.