Quiz Case

Multiple Brown Macules and Papules on a Female Teenager

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Figure 2.

Figure 3.

A 14-year-old Hispanic girl presented with a 1-year history of multiple asymptomatic hyperpigmented macules and papules over her arms, legs, trunk, and face. She was otherwise healthy and had normal growth and development. Her family history was noncontributory. Physical examination revealed multiple yellow-brown, 1- to 4-mm papules (Figure 1) on her axillae, shoulders, abdomen, and knees. She also had multiple light-brown macules on her arms, abdomen, and lower face area. She was also noted to have 2 café au lait macules (on her abdomen and left hip), without axillary or inguinal freckling or other evidence of neurofibromatosis. The findings of the rest of her general examination were otherwise unremarkable, with no hepatosplenomegaly or lymphadenopathy. Two punch biopsy specimens were obtained: one from a papular lesion (Figure 2 and Figure 3) and the other from a macule.

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Ashish Bhatia, MD, Web Editor, Archives of Dermatology.