A 51-year-old hypertensive and diabetic male patient, admitted due to acute kidney injury on top of chronic kidney disease, was referred to the dermatology service. He presented with a 3-month history of multiple discrete pruritic papules with keratotic plugs over the extensor aspects of the bilateral upper and lower extremities, initially managed as a case of scabies infestation but medications given provided no relief. Histopathologic analysis of a skin biopsy revealed findings of acquired perforating collagenosis. Resolution of lesions and pruritus were noted after starting on a topical corticosteroid ointment on the lesions, as well as hemodialysis to address the renal failure. Subsequent consults showed no recurrences and only a minor sequela of post-inflammatory hyperpigmentation.