Get 20M+ Full-Text Papers For Less Than $1.50/day. Start a 14-Day Trial for You or Your Team.

Learn More →

Numerous Skin-Colored Papules on the Face and Neck—Diagnosis

Numerous Skin-Colored Papules on the Face and Neck—Diagnosis Diagnosis: Fibroelastolytic papulosis. Diagnosis: Fibroelastolytic papulosis. Microscopic findings and clinical course Histological examination of hematoxylin-eosin stained slides demonstrated a normal-appearing epidermis and dermis. Elastic stains revealed focal absence of elastic fibers in the upper dermis. The clinical and pathological features were consistent with fibroelastolytic papulosis. Microscopic findings and clinical course We informed the patient of the benign nature of her condition and advised that evidence regarding treatment options remains limited. We offered a test dose of experimental therapy with a fractional laser, and the patient may plan to pursue this in the future. Diagnosis: Fibroelastolytic papulosis. Discussion Fibroelastolytic papulosis is a rare skin condition characterized by asymptomatic or minimally pruritic white-yellow papules that may coalesce into larger “cobblestone” plaques. It most commonly involves the neck and supraclavicular skin, although it can involve other areas of the body such as the face, trunk, and intertriginous skin. Most reported cases are described in white patients older than 40 years, with a predilection for women,1,2 although a recently published article reports this diagnosis in a 28-year-old Korean man.3 Discussion Histopathologic findings are characterized by markedly decreased or absent elastic fibers in the papillary and mid-reticular dermis. In some cases, there are thickened collagen fibers in the dermis. If the clinical picture is consistent with this diagnosis, it is necessary to perform elastic tissue stains because routine hematoxylin-eosin–stained sections often appear normal. Discussion The differential diagnosis includes anetoderma and mid-dermal elastolysis. While the histopathologic findings of anetoderma are similar to fibroelastolytic papulosis, these entities can be differentiated clinically. Mid-dermal elastolysis can be differentiated by the characteristic histopathologic finding of selective loss of elastic fibers within the mid-dermis with preservation of normal elastic tissue above and below. It was previously thought that the diagnoses of white fibrous papulosis of the neck and pseudoxanthoma elasticum-like papillary dermal elastolysis were distinct entities. However, a review of cases previously diagnosed as white fibrous papulosis of the neck and pseudoxanthoma elasticum-like papillary dermal elastolysis suggest that these are variants of a single disorder that is more appropriately termed fibroelastolytic papulosis.1 Most experts agree that changes associated with fibroelastolytic papulosis are age related.4 The marked predilection for women and the fact that our patient reported an abrupt onset shortly after her second pregnancy raises questions of a hormonal component contributing to this condition as well. To date, treatment has been disappointing. While fibroelastolytic papulosis is rare, it is likely underreported because of the benign and asymptomatic nature of the condition. Given the relatively distinctive clinical findings and the need for elastin-stained tissue evaluation, it is an important diagnosis for both clinicians and pathologists to recognize. Discussion Return to Quiz Case. References 1. Balus L, Amantea A, Donati P, Fazio M, Giuliano MC, Bellocci M. Fibroelastolytic papulosis of the neck: a report of 20 cases. Br J Dermatol. 1997;137(3):461-4669349351PubMedGoogle ScholarCrossref 2. Jagdeo J, Ng C, Ronchetti IP, Wilkel C, Bercovitch L, Robinson-Bostom L. Fibroelastolytic papulosis. J Am Acad Dermatol. 2004;51(6):958-96415583589PubMedGoogle ScholarCrossref 3. Song YC, Oh BH, Ko JH, et al. A case of fibroelastolytic papulosis on the neck of a young man. Ann Dermatol. 2011;23(2):193-19721747618PubMedGoogle ScholarCrossref 4. Rongioletti F, Rebora A. Fibroelastolytic patterns of intrinsic skin aging: pseudoxanthoma-elasticum-like papillary dermal elastolysis and white fibrous papulosis of the neck. Dermatology. 1995;191(1):19-248589477PubMedGoogle ScholarCrossref http://www.deepdyve.com/assets/images/DeepDyve-Logo-lg.png Archives of Dermatology American Medical Association

Numerous Skin-Colored Papules on the Face and Neck—Diagnosis

Archives of Dermatology , Volume 148 (7) – Jul 1, 2012

Numerous Skin-Colored Papules on the Face and Neck—Diagnosis

Abstract

Diagnosis: Fibroelastolytic papulosis. Diagnosis: Fibroelastolytic papulosis. Microscopic findings and clinical course Histological examination of hematoxylin-eosin stained slides demonstrated a normal-appearing epidermis and dermis. Elastic stains revealed focal absence of elastic fibers in the upper dermis. The clinical and pathological features were consistent with fibroelastolytic papulosis. Microscopic findings and clinical course We informed the patient of the benign nature of her...
Loading next page...
 
/lp/american-medical-association/numerous-skin-colored-papules-on-the-face-and-neck-diagnosis-cd7yUje4PH

References (4)

Publisher
American Medical Association
Copyright
Copyright © 2012 American Medical Association. All Rights Reserved.
ISSN
0003-987X
eISSN
1538-3652
DOI
10.1001/archderm.148.7.850-d
Publisher site
See Article on Publisher Site

Abstract

Diagnosis: Fibroelastolytic papulosis. Diagnosis: Fibroelastolytic papulosis. Microscopic findings and clinical course Histological examination of hematoxylin-eosin stained slides demonstrated a normal-appearing epidermis and dermis. Elastic stains revealed focal absence of elastic fibers in the upper dermis. The clinical and pathological features were consistent with fibroelastolytic papulosis. Microscopic findings and clinical course We informed the patient of the benign nature of her condition and advised that evidence regarding treatment options remains limited. We offered a test dose of experimental therapy with a fractional laser, and the patient may plan to pursue this in the future. Diagnosis: Fibroelastolytic papulosis. Discussion Fibroelastolytic papulosis is a rare skin condition characterized by asymptomatic or minimally pruritic white-yellow papules that may coalesce into larger “cobblestone” plaques. It most commonly involves the neck and supraclavicular skin, although it can involve other areas of the body such as the face, trunk, and intertriginous skin. Most reported cases are described in white patients older than 40 years, with a predilection for women,1,2 although a recently published article reports this diagnosis in a 28-year-old Korean man.3 Discussion Histopathologic findings are characterized by markedly decreased or absent elastic fibers in the papillary and mid-reticular dermis. In some cases, there are thickened collagen fibers in the dermis. If the clinical picture is consistent with this diagnosis, it is necessary to perform elastic tissue stains because routine hematoxylin-eosin–stained sections often appear normal. Discussion The differential diagnosis includes anetoderma and mid-dermal elastolysis. While the histopathologic findings of anetoderma are similar to fibroelastolytic papulosis, these entities can be differentiated clinically. Mid-dermal elastolysis can be differentiated by the characteristic histopathologic finding of selective loss of elastic fibers within the mid-dermis with preservation of normal elastic tissue above and below. It was previously thought that the diagnoses of white fibrous papulosis of the neck and pseudoxanthoma elasticum-like papillary dermal elastolysis were distinct entities. However, a review of cases previously diagnosed as white fibrous papulosis of the neck and pseudoxanthoma elasticum-like papillary dermal elastolysis suggest that these are variants of a single disorder that is more appropriately termed fibroelastolytic papulosis.1 Most experts agree that changes associated with fibroelastolytic papulosis are age related.4 The marked predilection for women and the fact that our patient reported an abrupt onset shortly after her second pregnancy raises questions of a hormonal component contributing to this condition as well. To date, treatment has been disappointing. While fibroelastolytic papulosis is rare, it is likely underreported because of the benign and asymptomatic nature of the condition. Given the relatively distinctive clinical findings and the need for elastin-stained tissue evaluation, it is an important diagnosis for both clinicians and pathologists to recognize. Discussion Return to Quiz Case. References 1. Balus L, Amantea A, Donati P, Fazio M, Giuliano MC, Bellocci M. Fibroelastolytic papulosis of the neck: a report of 20 cases. Br J Dermatol. 1997;137(3):461-4669349351PubMedGoogle ScholarCrossref 2. Jagdeo J, Ng C, Ronchetti IP, Wilkel C, Bercovitch L, Robinson-Bostom L. Fibroelastolytic papulosis. J Am Acad Dermatol. 2004;51(6):958-96415583589PubMedGoogle ScholarCrossref 3. Song YC, Oh BH, Ko JH, et al. A case of fibroelastolytic papulosis on the neck of a young man. Ann Dermatol. 2011;23(2):193-19721747618PubMedGoogle ScholarCrossref 4. Rongioletti F, Rebora A. Fibroelastolytic patterns of intrinsic skin aging: pseudoxanthoma-elasticum-like papillary dermal elastolysis and white fibrous papulosis of the neck. Dermatology. 1995;191(1):19-248589477PubMedGoogle ScholarCrossref

Journal

Archives of DermatologyAmerican Medical Association

Published: Jul 1, 2012

Keywords: neck,skin,papule

There are no references for this article.