A 10-year-old, spayed female, Pit Bull Terrier began developing a small, slightly erythematous, slightly firm region on the right dorsal shoulder. This progressed over several months to firm, nodular, thick, alopecic, crusted, slightly itchy skin along the dorsum/shoulders bilaterally. An impression smear revealed leukocytes and cocci. Improvement with cefpodoxime (Simplicef) was noted over a 1-1.5-month period with hair regrowth but no change in the thickened skin. Skin scrapes were negative for Demodex mites. At her latest exam, there was widespread firm dermal nodules forming plaques along the dorsum/lateral shoulders with alopecia and yellow crusts. There was occasional bleeding when scratched, and the lesions were mildly pruritic. The dog had elevated ALP and ALT.