Skin-Colored Papules on the Neck of a Postmenopausal Woman: A Diagnostic Challenge

Abstract

A 64-year-old patient presented for management of symptomatic skin-colored papules symmetrically distributed over the lateral neck over the past two years, which failed to improve on multiple topical corticosteroids, antifungal creams, and topical calcineurin inhibitor. Histopathologic examination showed a regular epidermis with increased melanophages in the papillary dermis, without vacuolar degeneration of the basement membrane. Verhoeff Van Gieson stain highlighted a band-like zone of attenuated elastic fibers in the papillary dermis, while Von Kossa stain was negative for calcified fibers. PAS staining was negative for fungal organisms and Alcian blue showed no increase in dermal mucin.

Keywords: acquired elastic tissue disorder; dermatopathology; histopathology; pseudoxanthoma elasticum-like papillary dermal elastolysis; trifarotene therapy.

Figure 1

(A) Dome-shaped skin-colored papules and plaques over the lateral neck. (B) Marked improvement after treatment.

Figure 2

(A) Biopsy shows a regular orthokeratotic epidermis with increased dermal melanophages (H&E, 10×). (B) High-power magnification showing attenuated elastic fibers in the papillary dermis (arrow) (H&E, 20×).

Figure 3

Verhoeff Stain (elastic stain) highlights the curved elastic fibers of the reticular dermis. Note the attenuation of the elastic fibers in the papillary dermis (Elastic stain, 20×).

Figure 4

Von Kossa staining of the tissue sample, highlighting the absence of calcium deposits at the level of the mid-dermis (Von Kossa, 5×).