Visual Diagnosis: 13-Year-Old Girl With Pink Papules

Abstract

1. Meghan M. Dickman, MD 2. Ilona J. Frieden, MD 1. University of California, San Francisco (UCSF), San Francisco, CA. A 13-year-old girl presents to the clinic with pink papules on her abdomen, legs, arms, and the lateral aspects of her cheeks. The lesions have been present for 4 years, always appearing in the same area, with satellite lesions surrounding the primary site. The rash blanches on palpation. The papules are primarily located on her abdomen and become more prominent and pruritic with sun exposure. The rash is most noticeable in the periumbilical region, where the patient’s metal pants button comes in contact with her skin. The papules are accompanied by pruritus for which she gets mild relief by taking oral antihistamines and applying topical corticosteroids. However, she has been unable to completely get rid of the rash with this regimen. The patient has an unremarkable medical history and is developing appropriately. There are no similar skin lesions on any close contacts. On physical examination, the patient has multiple pink papules on the bilateral aspects of her cheeks, upper arms, elbows, knees, and lower legs (Fig 1). All vital signs are within normal limits. There are papules that have coalesced into plaques surrounding her umbilicus (Fig 2), with lichenification. There is evidence of excoriation, without any ulcerations or bleeding. The remainder of the physical examination findings are unremarkable. Figure 1. Multiple papules were noted on the arms (left) and legs (right) of the patient. Figure 2. The initial location …