Quiz Case

Numerous Skin-Colored Papules on the Face and Neck

Figure 1.

Figure 2.

Figure 3.

A 36-year-old woman presented with a 9-month history of numerous small skin-colored papules scattered over her lateral cheeks, forehead, and neck. The papules were asymptomatic but cosmetically concerning. She reported that the papules developed rather suddenly after her second pregnancy. The patient has a history of rosacea previously treated with oral antibiotics and topical medications with improvement. At the time of her visit, she was using no medications besides an oral contraceptive. Physical examination revealed hundreds of skin-colored, flat-topped papules on the cheeks, forehead, chin, jaw, and lateral neck (Figure 1). Mild erythema and scattered inflammatory acneiform papules of the cheeks were also noted. Findings from a previous biopsy demonstrated perifollicular chronic inflammation consistent with rosacea. However, this diagnosis did not fit with her current clinical presentation. A skin biopsy was repeated, and the specimen was analyzed with hematoxylin-eosin (Figure 2) and elastic (Figure 3) staining.

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