Multiple Flesh-colored Papules Research Articles

An Isolated Presentation of Multiple Flesh-Colored Papules on the Dorsal Hands and Forearms: A Diagnostic Challenge

An Isolated Presentation of Multiple Flesh-Colored Papules on the Dorsal Hands and Forearms: A Diagnostic Challenge

A Case of Papulonodular Mucinosis in a Patient With Systemic Lupus Erythematosus

Papulonodular mucinosis is a distinctive lupus erythematosus cutaneous variant that generally occurs in patients with systemic lupus erythematosus. Despite a higher incidence of SLE in women, lupus cutaneous mucinosis occurs more frequently in men. Typically, papulonodular mucinosis appears as asymptomatic, flesh-colored papules and nodules with a propensity for the trunk and upper extremities. Herein, we report a case of papulonodular mucinosis associated with systemic lupus erythematosus in a middle-aged woman. On presentation, patient had multiple flesh-colored papules coalescing into plaques on the trunk and upper extremities. Histological findings of the lesions demonstrated a pale dermis secondary to profuse mucin deposition. Immunofluorescent staining revealed a 'lupus band' with granular deposition of immunoglobulins/complement proteins at the dermal-epidermal junction.

Multiple flesh-colored papules and plaques on the trunk

Multiple flesh-colored papules and plaques on the trunk

Multiple unilateral zosteriform syringomas on the abdomen.

Dear Editor: Syringomas are benign adnexal tumors of eccrine sweat duct origin. Clinically, they usually present as multiple, soft, skin-colored or yellowish papules and generally measure 1 to 2 mm in diameter. The sites of predilection are the face (especially the lower eyelids), cheeks, thigh, and axilla in a symmetrical or bilateral fashion1. A 39-year-old female patient presented with asymptomatic multiple flesh-colored papules on her trunk. The lesions had developed in crops about a month previously. Without spontaneous regression or improvement, the lesions had increased in number gradually. The patient's medical history was unremarkable, and she was not on any medication. She had no family history of similar skin lesions. Physical examination revealed multiple, flesh-colored to light-brownish, 2 to 4-mm-diameter papules across the right side of the trunk (Fig. 1). The lesions had a zosteriform distribution along the right T8 and T9 dermatomes. No other lesions were observed elsewhere on the whole body. Histopathological examination of the abdomen revealed numerous epithelial strands and small ducts in a fibrous stroma of the upper dermis (Fig. 2). Taking the clinicopathological features into consideration, the lesions were diagnosed as zosteriform syringomas and were successfully treated with carbon dioxide laser. The patient was followed for 6 months after the treatment, without any sign of recurrence and new lesion formation elsewhere on the whole body. Fig. 1 (A, B) Multiple, flesh-colored to light-brownish papules across the right side of the trunk in a zosteriform distribution (arrows). (C) Close-up view of the lesion. Fig. 2 Histopathological findings showing numerous epithelial strands and ductal differentiation in a fibrous stroma of the upper dermis (HE A: ×40, B: ×100). Syringomas usually present with a bilateral or symmetrical distribution. Although Hayashi et al.2 and Goday et al.3 reported about unilateral linear syringomas on the arm, until now cases of zosteriform syringomas have not been reported in the Korean literature. There was only one case report by Ceulen et al.4 in 2008 in Europe. In that case, the syringomas were distributed on the left side of the chest of an 18-year-old Caucasian male patient. Here, we report the first case of unilateral zosteriform syringomas on the right side of the abdomen. Typical periorbital syringomas may be easy to diagnose; however, when they show an unusual clinical manifestation, they could be misdiagnosed as sebaceous hyperplasia, milia, acne vulgaris, or lichen planus5. When encountering unilateral, zosteriform, popular dermatosis, dermatologists should consider syringomas in the differential diagnosis. The case presented here is a rare clinical form of syringomas that occurred in a zosteriform fashion. Although further investigations of the cellular and molecular levels are needed to uncover the precise pathogenesis of syringomas, we suggest that unilateral zosteriform patterns may well provide clues to the pathogenesis of syringomas with unknown etiology.

Papules on the Eyelids, Lips, and Tongue

A 16-year-old boy presented with multiple flesh-colored papules and dermal nodules on his eyelids, lips, and tongue (Panels A, B, and C, respectively). Six years earlier, his mother had received a diagnosis of metastatic medullary thyroid cancer, at the age of 38 years. At that time, both of her sons were found to have markedly elevated serum calcitonin levels but no biochemical evidence of pheochromocytoma. Both boys subsequently underwent total thyroidectomy. On pathological examination, a medullary thyroid tumor measuring 0.5 cm by 0.5 cm had been discovered in the thyroid gland of this patient. This clinical history is suggestive of . . .

Birt-Hogg-Dubé Syndrome, a Rare Case in Korea Confirmed by Genetic Analysis

Simple benign tumors can present as part of a syndrome with substantial mortality. Fibrofolliculomas are benign skin tumors most often associated with the Birt-Hogg-Dubé syndrome (BHDS). The most life-threatening complication of this syndrome is renal cancer and other major features include multiple lung cysts and spontaneous pneumothorax. We present the case of a 54 year-old man with multiple flesh-colored papules on his face confirmed histologically as fibrofolliculomas. He had a history of recurrent pneumothorax and chest computed tomography showed multiple lung cysts. To confirm the diagnosis of BHDS, we conducted gene analysis that revealed a single nucleotide duplication in the folliculin (FLCN) gene (Exon 11, C.1285dupC). BHDS confirmed by the FLCN gene mutation is rarely reported in Korea. Appropriate investigation is recommended whenever a patient with benign skin tumors is encountered.

Multiple flesh-colored papules on the waist and multiple purpuric nodules on the tongue

An 83-year-old man presented with a 1-month history of multiple flesh-colored waxy papules over his bilateral waist, and bilateral inguinal and suprapubic areas. He had also noted multiple blister-like nodules over his buccal mucosa and various-sized purpuric tumors on his tongue for over a year. Both types of lesions were asymptomatic. His medical history included hypertension, chronic renal insufficiency, and previous cerebrovascular accident, and he was regu-larly followed up at our hospital. There was no relevant family history and no constitutional symptoms, except for a 1-month history of right hip and right shoulder pain.Two skin biopsy specimens were obtained from the ab-domen and lip. Histopathologic examination of the ab-dominal papule revealed a large amount of pink amorphous deposits in the superficial dermis. Histopathologic exami-nation of the lip showed similar deposits in the submucosa and small vessel walls. Congo red staining of both speci-mens revealed green birefringence under polarized light.Protein electrophoresis revealed a pattern indicative of monoclonal gammopathy, with a spike in the beta region. Immunofixation electrophoresis of blood and urine disclosed IgA-lambda paraprotein and lambda light chain parapro-tein, respectively. Biopsy results from the bone marrow re-vealed sheets of plasma cells, including some immature forms, and occasional Dutcher bodies. The plasma cells accounted for up to 70% of all nucleated cells focally. No evidence of bone or renal involvement was found in skull X-ray or renal echo examinations. However, magnetic reso-nance imaging of the heart revealed abnormal thickening and akinesia of the septal wall of the left ventricle.

Normolipemic xanthomas on the ears of an adolescent

To the Editor: A 15-year-old healthy black female reported a 1-year history of occasionally painful ear nodules. She denied antecedent trauma. Examination revealed multiple flesh-colored papules and nodules on the bilateral helices ranging in size from 0.5 to 2.7 cm (Figs 1 and 2). One nodule in the threshold of the left auditory canal caused a hearing deficit, which was corrected by pulling down on the earlobe. Family history was significant for keloids. Clinical differential diagnosis included epidermal cysts, lipomas, pseudocysts of the auricle, traumatic auricular hematoma (cauliflower ear), and angiolymphoid hyperplasia.

Siringomas vulvares

Abstract—Syringomas are benign adnexal tumors that present as multiple flesh-colored papules on the scalp, forehead, neck, anterior thorax, axillae, lower half of the abdomen and limbs. Their appearance in the genital area is infrequent. They develop after puberty, more frequently in women, and are usually asymptomatic. We present the case of a 19-year-old patient with symmetrical and bilateral syringomas in the vulvar region.