A 25-year-old white man with no significant personal or family medical history was referred for evaluation of an asymptomatic papular eruption on his arms and legs of approximately 4 years' duration. Treatment with topical corticosteroids had been unhelpful.
On physical examination, the patient was found to have multiple 4- to 5-mm red keratotic papules with a central adherent plug (Figure 1 and Figure 2). Some were discrete lesions, and others were arranged in a serpiginous pattern found symmetrically on the anterior aspect of the forearms and legs. There were no other relevant skin findings. Both the complete blood cell count and the results of blood chemistry tests were within normal limits. Echocardiographic and ophthalmologic studies showed no abnormalities. A biopsy specimen was obtained (Figure 3 and Figure 4).
Nagore E, Sánchez-Motilla JM, Pérez-Ferriols A, Aliaga A. A Long-standing Keratotic Papular Eruption. Arch Dermatol. 2000;136(3):417-422. doi: