Yellowish Papules Research Articles

Upper eyelid juvenile xanthogranuloma: a case report

Juvenile xanthogranuloma is a rare benign non-Langerhans cell histiocytosis. Clinical manifestation usually occurs up to the age of 2 years, with yellowish papules and variable clinical progression. Approximately 0.75% of patients had systemic involvement and 0.25%, ocular alterations. The purpose of this report is to describe a case of a preschool 2-year-old female patient, with nodules in the upper right eyelid, 0.5-cm wide, with well-defined edges, an uncertain date of onset, a stable growth for 6 months, with no [...]

The dermoscopic features of facial aging among diverse ethnicity in Medan, Indonesia

Background: Aging is an inevitable process, and skin is the body organ that most demonstrates this process. Skin aging occurs due to two continuous processes, which are intrinsic and extrinsic. Dermoscopy is a non-invasive technique that allows physicians to rapidly observe skin aging in vivo and visualize the morphological structures that are invisible to the naked eyes. Dermoscopic features of facial aging might differ in various ethnic groups. Medan is a multi-ethnic city; thus might show facial skin aging differently. This study investigated the dermoscopic features of facial aging among various ethnic groups in Medan, Indonesia.Methods: This descriptive study was a cross-sectional study design with 164 subjects from 10 ethnicities in Medan. Subjects were sampled based on ethnic group by quota sampling technique with inclusion and exclusion criteria. Each subject was evaluated for dermatological history and physical examination. The assessment of facial aging is based on the Dermoscopy Photoaging Scale (DPAS) using 11 criteria. The data then processed in the SPSS program ver 23 then presented in descriptive with percentages. Results: Most of the subjects were Javanese ethnic (30.5%). The age group 30 - 39 years old has the highest frequency (59.1%). Most of them were in married status (87.2%). DPAS criteria showed yellowish discoloration (97.0%), ephelids/lentigo (96.3%), and superficial wrinkle (96.3%0 were the three most dermoscopic features. Each ethnic has its dominant dermoscopic features and various with the others ethnic.Conclusion: Yellowish discoloration, ephelid/lentigo, telangiectasis and superficial wrinkles were the dominant dermoscopy features. Meanwhile, yellow papules, actinic keratoses and criss-cross wrinkles were rarely observed, and senile comedones were not found in this study.

A case report of generalised eruptive syringoma: a rare variant of syringoma

<p class="abstract">Syringomas are benign adnexal neoplasm of eccrine sweat duct usually affecting adult women. They present as firm, skin coloured to yellowish papules in a symmetrical distribution over periorbital region. Eruptive syringomas are infrequent and usually appear at uncommon sites. Herein, we report a case of a 21-year old girl with eruptive syringomas with an extensive involvement.</p>

28144 Cobblestoned skin on neck: The differential

Pseudoxanthoma elasticum-like papillary dermal elastolysis (PXE-like PDE) is a benign cutaneous condition that mimics pseudoxanthoma elasticum (PXE). PXE is a hereditary distortion and calcification of elastic fibers, not only in cutaneous tissue, but in cardiac and ocular tissues. Histopathology is an important diagnostic tool to distinguish between the two and can save the patient from an extensive work-up if misdiagnosed as PXE. We present, herein, a 62-year-old healthy female of with an asymptomatic papular rash on her neck for 8 months. She wears a hijab, and reports frequent heat and sweat. The patient failed topical steroid creams given by her primary care provider. Exam showed multiple skin-colored to yellow smooth papules on the bilateral and posterior neck, and bilateral antecubital fossae. Biopsy from her left neck showed abrupt loss of elastic fibers in the papillary dermis with a Verhoeff-van Gieson stain. A von Kossa stain did not demonstrate calcium deposition, ruling out PXE. PXE-LPDE is likely an underdiagnosed acquired condition that occurs most commonly in women after the sixth decade of life and has overlapping clinical and histopathologic features with white fibrous papulosis, another benign condition that can be argued is the same entity. We favored PXE-LPDE in our patient due to the band-like loss of elastic fibers in the papillary dermis. Although chronic sun exposure has been implicated in its pathogenesis, our patient has been sun protected for most of her life. Unfortunately, no specific therapy has been shown to be successful in the treatment of PXE-like PDE.

Neonatal systemic juvenile Xanthogranuloma with Hydrops diagnosed by Purpura skin biopsy: a case report and literature review

BackgroundSystemic juvenile xanthogranuloma is a very rare disease typically presents as skin lesions with yellow papules or nodules and is sometimes fatal. We report a case of congenital neonatal systemic juvenile xanthogranuloma with atypical skin appearance that made the diagnosis difficult.Case presentationA preterm Japanese female neonate with prenatally diagnosed fetal hydrops in-utero was born with purpuric lesions involving the trunk and face. Since birth, she had hypoxemic respiratory failure, splenomegaly, anemia, thrombocytopenia, coagulopathy, and was transfusion dependent for red blood cells, fresh frozen plasma, and platelets. Multiple cystic lesions in her liver, part of them with vascular, were detected by ultrasound. A liver biopsy was inconclusive. A skin lesion on her face similar to purpura gradually changed to a firm and solid enlarged non-yellow nodule. Technically, the typical finding on skin biopsy would have been histiocytic infiltration (without Touton Giant cells) and immunohistochemistry results which then would be consistent with a diagnosis of systemic juvenile xanthogranuloma, and chemotherapy improved her general condition.ConclusionsThis case report shows that skin biopsies are necessary to detect neonatal systemic juvenile xanthogranuloma when there are organ symptoms and skin eruption, even if the skin lesion does not have a typical appearance of yellow papules or nodules.

Congenital cutaneous non‐neural granular cell tumor mimicking herpetic infection: Case report and review of the literature

We present a case of a female neonate with a cluster of six skin colored to yellowish pseudovesicular papules on her right forearm present since birth, initially thought to be a herpes simplex virus infection. Punch biopsy with immunostaining revealed a diagnosis of S100-negative, CD163-positive congenital cutaneous non-neural granular cell tumor. Only four other reports are presented in the literature of this entity, three of which also presented on the arm with somewhat similar clinical findings. We briefly reviewed the subtypes of classic and S100-negative non-neural granular cell tumors.

Painful papules on the dorsum of the tongue

A 10-year-old boy presented with a 5-day history of a painful eruption of the tongue, accompanied by difficulty in feeding, excessive salivation and intermittent fever. Physical examination revealed multiple pink papules on the anterior part of the dorsum of the tongue (Fig. 1). There were no other mucosal, labial or skin lesions. He had submental and submandibular lymphadenopathy. What is the most likely diagnosis? (Answer on page ••) The topography of the lesions corresponded to the location of fungiform papillae. A clinical diagnosis of eruptive familial lingual papillitis (EFLP) was made. The eruption resolved spontaneously within 5 days. EFLP is an acute inflammatory condition involving the fungiform papillae of the tongue that affects especially children, with a median age of 3.5 years.1 Although the exact aetiology is unknown, viral infections have been suggested as a trigger factor.2 Clinically, EFLP is characterised by an acute onset of multiple erythematous, whitish to yellow or pink papules that correspond to enlarged fungiform papillae. The eruption involves typically on the tip, the lateral borders and/or the dorsum of the tongue.3 Pain, burning or itch, difficulty in feeding and excessive salivation are usually associated. Fever and cervical lymphadenopathy may also be noted. Familial transmission is possible.2 In our case, no other family members had experienced a lingual eruption. Spontaneous resolution is seen in 1 day to 3 weeks. However, recurrence is possible.1

A Comparison of Efficacy and Safety of Fractional Carbon Dioxide Laser and Fractional Er:YAG Laser for the Treatment of Xanthelasma Palpebrarum: A Two-Center Randomized Split-Face Controlled Trial

Background: Xanthelasma palpebrarum (XP) is a form of cutaneous xanthoma that presents as collections of yellowish papules or plaques around the eyelids or canthus, affecting patients cosmetically. Objective: This study aimed to compare the efficacy and safety of fractional carbon dioxide (CO2) laser to that of fractional Er:YAG laser for the treatment of XP. Methods: Two centers recruited patients diagnosed with XP of bilaterally symmetrical lesions. The lesion on one side was randomly assigned to be treated with fractional CO2 laser while the lesion on the other side was treated with fractional Er:YAG laser. All subjects received up to five treatments, with a 4-week interval between each treatment. Results: Thirty-nine patients completed the study and a total of 82 lesions were available for final assessment. The percentage of "Excellent Improvement" on third and fourth visit was 60.98% versus 39.02% and 90.24% versus 63.41%, respectively, p < 0.05. In a follow-up for 12 to 25 months, the number of lesions recurred on the side treated with fractional CO2 laser and fractional Er:YAG laser are 9 (22%) and 10 (24%), respectively. Conclusions: In this study, fractional CO2 laser therapy appears superior since a fewer treatments are required for patients to show significant clinical improvement.

Yellow papules and nodules in an infant

Yellow papules and nodules in an infant

Favre-racouchot syndrome: Case report

It is also known as nodular elastosis with cyst and comedones. The pathophysiology of disease causation is unknown, the condition may arises due to prolonged sun exposure. We report a case of 68 year old male agriculturist who presented with dark colored raised lesions along with thickening of facial skin which was increasing progressively since past three years. Physical examination showed the presence of thickened inelastic skin along with deep furrows and wrinkles involving the entire face, along with multiple open and closed comedones yellowish papules and nodules clustered especially around periocular region and dorsum of nose. On histopathological examination epidermis showed epidermal cyst formation containing laminated keratin and superficial dermis shows follicular infundibular plugging and large nodules filled with keratinous material. Keywords: Prolonged sun exposure, Bilateral, Nodular elastoidosis with cyst and comedones.

18476 Scattered yellow papules in a pediatric patient: Diagnostic importance of distinguishing juvenile xanthogranuloma from xanthelasmoid mastocytosis

Mastocytosis encompasses a spectrum of conditions characterized by abnormal accumulation of mast cells in the skin or other internal organs. While urticaria pigmentosa is the most common clinical variant of mastocytosis, a rare presentation with yellowish lesions resembling xanthomas can also develop, and can be often misdiagnosed as juvenile xanthogranuloma (JXG). We present a case of a 6-year-old boy with a 4-year history of pruritic yellow to orange papules scattered over the scalp, neck, and trunk.

Pseudoxanthoma elasticum–like papillary dermal elastolysis: A mimicker of genetic pseudoxanthoma elasticum

Pseudoxanthoma elasticum (PXE)–like papillary dermal elastolysis (PDE) is an acquired, rare, elastic tissue disorder that presents with multiple asymptomatic, nonfollicular yellowish or normochromic papules, coalescing into symmetrical cobblestone plaques, with a predilection for the neck of postmenopausal women. The condition develops slowly, in months to years, and, although clinically similar to PXE, it is devoid of any systemic implication, being only of esthetic concern. The etiology is unknown, but it is speculated that there is a multifactorial pathogenesis, with the contribution of intrinsic aging, exposure to ultraviolet radiation, abnormal elastogenesis, and genetic factors. The diagnosis is confirmed by histopathology, with special stains specific for elastic fibers revealing loss of elastic plexus in the papillary dermis and the presence of melanophages. Its prevalence is probably underestimated, which reinforces the importance of better clinical and histologic identification to distinguish it from inherited PXE and to avoid extensive systemic investigations and unnecessary medical visits for the patient.

2020 European guideline on the management of genital molluscum contagiosum.

Molluscum contagiosum is a benign viral epidermal infection associated with high risk of transmission. The guideline is focused on the sexually transmitted molluscum contagiosum. The diagnosis is clinical with characteristic individual lesions, termed 'mollusca', seen as dome-shaped, smooth-surfaced, pearly, firm, skin-coloured, pink, yellow or white papules, 2 - 5mm in diameter with central umbilication. Dermoscopy may facilitate diagnosis. Therapeutic options are numerous, including physical treatments (cautery, curettage and cryotherapy), topical chemical treatments (e.g. podophyllotoxin and imiquimod) or waiting for spontaneous resolution in immunocompetent patients. In pregnancy, it is safe to use physical procedures (e.g. cryotherapy). Immunosuppressed patients develop severe and recalcitrant molluscum lesions that may require treatment with cidofovir, imiquimod or interferon. Patients with molluscum contagiosum infection should be offered to be screened for other sexually transmitted infections.

UNUSUAL CLINICAL PRESENTATION OF FORDYCE GRANULES

Fordyce first described these ectopic sebaceous glands within the oral mucosa that cannot be associated with any hair structures inside mouth. In fact, they are considered to be a normal variation and can be seen in approximately 80% to 90% of the adult population. The most prevalent sites are the vermilion of the lips and the buccal mucosa. A 31-year-old man presented to our service with a main complaint of draining pus from his gums for the last year. Clinical examination revealed presence of granular yellowish papule in the alveolar mucosa between teeth 13/14 with a drainage orifice of yellowish and thick content inside. It was also possible to visualize a similar lesion on the contralateral region, teeth 23/24, but without draining. Radiographic examination was normal. Provisional diagnoses were Fordyce granules and fistula. An excisional biopsy was performed, and histologic diagnosis was Fordyce granules. This case represents an unusual clinical presentation of Fordyce granules.

Isolated Cutaneous Langerhans Cell Histiocytosis Presenting in an Adult Male

Langerhans cell histiocytosis (LCH) is an infrequent clonal proliferative disorder of myeloid dendritic cells. It has a wide variety of cutaneous manifestations and retains the possibility of systemic implications. Because LCH is predominantly a disease of childhood, there are well-established clinical definitions, as well as guidelines regarding workup and treatment, in the context of pediatric disease. Here we present a case of isolated cutaneous LCH in an adult male, followed by a discussion of our diagnostic plan and treatment course. The patient exhibited a small, excoriated, yellow papule on his inferior forehead during a skin examination. The specimen underwent tangential shave biopsy; histopathologic evaluation with appropriate immunohistochemical staining confirmed a diagnosis of cutaneous LCH. After thorough investigation via serologic and imaging diagnostics, we confirmed isolated cutaneous disease. The patient underwent wide local excision (WLE) with no evidence of recurrence. It is crucial to appropriately screen all patients diagnosed with cutaneous LCH for internal organ involvement. The authors aim to highlight the need for further investigations to ultimately dictate standardized management and treatment for isolated cutaneous LCH in the adult population.

Palmoplantar hyperkeratotic projections

Palmoplantar hyperkeratotic projections

Eruptive xanthomas: a warning sign of future hyperlipidemia complications

&lt;p&gt;Eruptive xanthomas are localized lipid deposits in the skin or subcutaneous tissue that are associated with both primary and secondary hyperlipidemia. Typical presentation manifests as small yellow papules on the buttocks or extensor surfaces. Xanthomas can be diagnosed clinically with an extensive history and physical examination, however, can be confirmed via biopsy and histological findings. It is essential to identify the underlying cause of the skin lesions and take appropriate measures to prevent future hyperlipidemia-induced consequences. Here we report a 42-year-old female with eruptive xanthomas on her trunk and extremities. Previous visits to the primary care provider and emergency department resulted in diagnoses of viral exanthems. The consulted dermatologist ordered laboratory tests remarkable for extreme hypertriglyceridemia, hypercholesterolemia, and hyperglycemia. Lifestyle modification in conjunction with cholesterol and triglyceride lowering medications led to the resolution of abnormal laboratory findings and remission of eruptive xanthoma lesions.&lt;/p&gt;

Pseudoxanthoma Elasticum.

CASE REPORT A 57-year-old man presented to the emergency department for evaluation of hematemesis. Physical examination was notable for complete blindness and 2–3 mm yellow papules with increased density around the neck, antecubital area, popliteal fossa, axillary folds, and periumbilicus (Figure 1). An esophagogastroduodenoscopy was scheduled, which revealed fresh blood in the fundus with several large clots in the stomach, limiting further visualization (Figure 2). Subsequent angiography revealed active multifocal hemorrhage along the path of the proximal left gastric artery which was embolized (Figure 3). However, within 3 hours, the patient began to bleed once more. The general surgery team was consulted, but on learning from the patient's wife that he had a previously undisclosed diagnosis of pseudoxanthoma elasticum (PXE), operative management was deferred. A second angiography revealed no new bleeding vessels, but the right gastric artery was empirically coiled. The patient tolerated the procedure well, continuing to remain stable with steady improvement in his hemoglobin. Five days after admission, the patient made a full recovery and was discharged home.Figure 1.: Physical examination noting yellow, irregularly shaped papules, 2–3 mm in size coalescing into plaques around (A) the neck, (B) the antecubital area, and (C) the popliteal fossa.Figure 2.: A large clot in the fundus area of the stomach as visualized by endoscopy.Figure 3.: Angiography revealing (A) bleeding in the proximal left gastric artery with (B) successful coiling.Pseudoxanthoma elasticum is an inherited multisystem connective tissue disorder that results in fragmentation and calcification of elastic fibers. Over 80% of affected individuals present with 2–10 mm sized yellow skin papules with a predilection for the neck and flexural areas.1 PXE also causes gastrointestinal (GI) hemorrhage in approximately 13% of affected individuals, which occurs because of degeneration of arterial elastic fibers in the mucosa of the stomach and intestine.2 Early recognition and diagnosis of PXE-associated GI bleeding can lead to improved outcomes because the bleeding in this patient population is usually recurrent and life-threatening.1 However, because the GI manifestations of PXE are uncommon, the underlying diagnosis is frequently missed. In cases where PXE is suspected, a skin examination with particular attention to the neck and flexural areas is crucial.1 Ophthalmologic manifestations of PXE are also an identifiable sign of the disease, and a fundal examination looking for angioid streaks or choroidal neovascularization in those with suspected vascular involvement should be performed.3 Other vascular signs such as intermittent claudication in all extremities and peripheral artery disease can be seen secondary to dystrophic mineralization of connective tissue.1,4,5 Therefore, a detailed extremity and cardiovascular examination should be conducted in all patients suspected of having PXE. DISCLOSURES Author contributions: All authors contributed equally to this manuscript. S. Qian is the article guarantor. Financial disclosure: None to report. Informed consent was obtained for this case report.

Juvenile xanthogranulomas: Examining single, multiple, and extracutaneous presentations

Juvenile xanthogranuloma (JXG) is a non-Langerhans cell histiocytosis characterized by yellowish papules in the skin. JXGs most often occur in infancy or early childhood and are typically solitary and asymptomatic, often regressing after several years. While JXGs predominantly occur on the skin, extracutaneous JXGs also exist. In this paper, we review the literature on single, multiple, and visceral JXGs and provide recommendations on monitoring and work-up. A literature review was conducted with the PubMed database using selective search terms for single, multiple, ocular, and visceral lesions as well as NF1/JMML. JXG is typically a self-limited disorder if lesions are cutaneous and singular. While rare, JXGs may manifest as multiple and extracutaneous lesions. Further screening and referral to specialists may be warranted in these cases based on age and extent of involvement. Our review demonstrates common presentations of single, multiple, and extracutaneous lesions in addition to those that occur with NF1 and JMML. We suggest patients be evaluated on a case-by-case basis by a dermatologist and referred to specialists as appropriate.

Clustered yellowish papules on the cheek.

Clustered yellowish papules on the cheek.