Abstract

W HITE FIBROUS PAPULOSIS OF THE NECK (WFPN), which was first described by Shimizu et al in 1985, clinically presents as asymptomatic white papules, measuring 2 to 3 mm in diameter, on the neck of elderly persons. The lesions are round to oval, clearly marginated, and unrelated to hair follicles. The lesions shown in Figures 1, 2, 3, and 4 were located on the neck of a 58-year-old Japanese man (Figures 1 and 2) and a 68-year old Japanese man (Figures 3 and 4). Dermoscopy of both lesions revealed clearly circumscribed, homogeneous, white areas, including dotted or short, thin vessels, without follicular involvement. Peripheral pigmentation can be seen but fails to form a pigment network (Figures 1 and 2). The diagnosis of WFPN was confirmed histopathologically in both cases (Figure 5 and Figure 6 [hematoxylin-eosin, original magnification 100]). The histopathologic characteristics of WFPN include relatively well-circumscribed areas consisting of thickened collagen bundles in the papillary to middle dermis, without vascular proliferation, and a decrease of melanin content in the epidermis. These histopathologic features are consistent with the white, nodular, dermoscopic appearance. The differential diagnosis includes dermatofibroma, which is less well circumscribed and has a peripheral delicate pigment network. Furthermore, dermatofibromas have been noted to be erythematous (31.5%) and include dotted vessels (30.6%). Ten patterns of dermatofibroma have been described, but none matches our cases of WFPN. The differential diagnosis of WFPN may also include sebaceous hyperplasia and molluscum contagiosum, which are both distinguishable because of the presence of crown vessels. The dermoscopic features of WFPN may be unique and include homogeneous, white, wellcircumscribed lesions punctuated with dotted or short, thin vessels.

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