Pedunculated Pink Papule on the Nose.

A 57-year-old woman presented to Dermatology for a rosacea follow-up appointment. During the visit, she mentioned a painful lesion on her thigh that had been present for at least a month. An exam revealed a 4- to 5-mm pink ulcerated papule. Dermoscopy did not reveal any pigmentary features of a melanocytic lesion (network, streaks, globules, or homogeneous blue color) but there was 1 markedly atypical serpentine vessel.1What’s your diagnosis?

Juvenile hyaline fibromatosis ( JHF ) is a rare autosomal recessive disease characterized by papulonodular skin lesions, gingival hyperplasia, joint contractures, and bone lesions. The skin lesions may consist of multiple large tumors, commonly on the scalp and around the neck, and small pearly, pink papules and plaques on the trunk, chin, ears, and around the nostrils. Here, we report a 2-year-old boy with characteristic stiffness of the knees and elbows and pink confluent papules on the paranasal folds, and periauricular and perianal regions. He also had hard nodules all over the scalp and around the mouth, and severe gingival hyperplasia. The lesions were totally excised and clinicopathological diagnosis was JHF.

A 50-Year-Old Man With Skin Lesions and Multiple Pulmonary Nodules

Introduction Condyloma acuminatum (CA), also known as genital warts, is an anogenital warty growth caused by some types of the human papilloma virus (HPV). CA is usually found within the anal or genital area, but it occasionally presents in the oral, respiratory, conjunctival, nasal, or nipple region. We herein report a rare case of a 29-year-old Chinese woman with a tiny CA on her nipple, which was diagnosed through dermoscopy. With noninvasion and convenience, dermoscopy is valuable for the early diagnosis of tiny CA that is unable to be discerned by the naked eye. Case report A 29-year-old Chinese woman presented with a one-week history of a pink papule affecting her right nipple. The lesion was asymptomatic. Just two months ago, she had been diagnosed with CA caused by HPV-6 and HPV-18 and treated with carbon dioxide (CO2) laser in Chengdu Second People's Hospital. Physical examination revealed a pink papule with a size of millet at the center of her right nipple (Fig. 1A). Dermoscopy showed fingerlike patterns with hairpin and dotted vessels within the papillae (Fig. 1B). The acetowhitening test was positive, and real-time polymerase chain reaction (PCR) amplification positively detected HPV-18 sequences. In addition, a test for antihuman immunodeficiency virus antibody (HIV-Ab), the Treponema pallidum particle agglutination assay, and the tolulized red unheated serum test all produced negative results.Figure 1: Clinical and dermoscopic features of the lesion. (A) A pink papule with a size of millet at the center of the right nipple. (B) Dermoscopy shows fingerlike patterns with hairpin or dotted vessels within the papillae (×50).Based on these findings, we diagnosed this patient with CA on the nipple and started treatment with liquid nitrogen cryotherapy and topical 5% imiquimod cream. There has been no recurrence in the ensuing three months. Discussion CA is a sexually transmitted infection caused by certain types of HPV, most commonly HPV-6 and HPV-11. Suzanne et al.1 used PCR to assess the lesions of 472 patients with CA and detected a total of 14 HPV genotypes (6, 11, 16, 18, 31, 33, 35, 39, 45, 51, 52, 56, 58, and 59), of which HPV-6 and HPV-11 were the dominant types (94.7%) followed by HPV-16 and HPV-18. HPV-16 and HPV-18 accounted for 50% of the 22 CA patients, who were positive for a high-risk HPV genotype. Although CA usually occurs in the anal or genital area, it occasionally presents in the oral, respiratory, conjunctival, nasal, or nipple region. The anogenital HPV infection is almost acquired through sexual contact. The lesions are characterized by localized single or multiple papules without any symptoms in the early stage, which gradually develop into papillary, cristate, cauliflower-like, or crumby neoplasms. To date, a few cases of CA on the nipple have been reported. Wood2 reported the first case of CA on the nipple in 1978. Later, Kulke et al.3 cloned HPV-6 subtype from a CA located on the nipple, and Kowalzick et al.4 described a case of CA on the nipple associated with HPV-41. In 2014, Saeki et al.5 reported a case of CA on the nipple and areola that resembled seborrheic keratosis. This patient visited our clinic again for a new tiny papule on her nipple. If she had not been previously diagnosed with genital CA, we might have easily ignored such a tiny lesion. Then, dermoscopy showed typical wart manifestations, and HPV-18 sequences were positively detected by real-time PCR. However, there have been no reports of the correlation between HPV-18 and verruca vulgaris. In view of her history of CA caused by both HPV-6 and HPV-18, our patient was diagnosed with CA on the nipple. In most cases, clinicians familiar with the clinical manifestations of CA can easily make a diagnosis only based upon a physical examination. However, examination with a dermoscopy is helpful for diagnosing CA when the lesions are particularly small or atypical.6-7 The specific dermoscopic findings of CA include morphologic patterns (fingerlike, knoblike, mosaic-like) and multiple vascular features (glomerular/dotted, hairpin).6 As a noninvasive and convenient examination method, dermoscopy is valuable for the early diagnosis of tiny CA that is unable to be discerned by the naked eye.

Solitary pink papule in an elderly man

Urticarial dermatitis herpetiformis: A rare presentation of an uncommon disorder

Pigmented eccrine poroma: report of an atypical case with the use ofdermoscopy*

Immune-related sarcoidosis observed in combination ipilimumab and nivolumab therapy

Craniofacial features of isotretinoin embryopathy

Man With Bumps on His Shin

The lesion of the ear herein described is reported in view of its similarity to and frequent confusion with chondrodermatitis nodularis chronica helicis, and because it constitutes a unique cutaneous reaction to prolonged pressure. I have observed such lesions of the ear only in women after the wearing of tight-fitting hats, in telephone operators after the use of ear pieces and in nuns after the wearing of stiffly starched bonnets. The lesions occur singly, involving one or both ears, and are soft, pink papules; the surface is smooth and flat-topped; they are freely movable, not infiltrated and not tender. The lesions are nodular, but in the absence of infiltration they are more properly described as papules. Pain is not a characteristic symptom. They occur on the center, the most prominent part, of the anthelix. Their appearance in women at this location seems to be as typical as is the location

Treatment of segmental keratosis follicularis (Darier disease) using ablative fractional laser resurfacing.

Recurrent erythematous papules on the chest

A 50-year-old woman with a history of kidney transplant presented with 2 days of abdominal pain after 6 months of recurrent streptococcal pharyngitis, fevers, weight loss and a new rash...

A few pink papules in an adult woman: Incidental finding leads to diagnosis of hereditary leiomyomatosis and renal cell cancer