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February 2010

Dermoscopy of White Fibrous Papulosis of the Neck

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Arch Dermatol. 2010;146(2):220. doi:10.1001/archdermatol.2009.368

White fibrous papulosis of the neck (WFPN), which was first described by Shimizu et al1 in 1985, clinically presents as asymptomatic white papules, measuring 2 to 3 mm in diameter, on the neck of elderly persons. The lesions are round to oval, clearly marginated, and unrelated to hair follicles. The lesions shown in Figures 1, 2, 3, and 4 were located on the neck of a 58-year-old Japanese man (Figures 1 and 2) and a 68-year old Japanese man (Figures 3 and 4). Dermoscopy of both lesions revealed clearly circumscribed, homogeneous, white areas, including dotted or short, thin vessels, without follicular involvement. Peripheral pigmentation can be seen but fails to form a pigment network (Figures 1 and 2). The diagnosis of WFPN was confirmed histopathologically in both cases (Figure 5 and Figure 6 [hematoxylin-eosin, original magnification ×100]). The histopathologic characteristics of WFPN include relatively well-circumscribed areas consisting of thickened collagen bundles in the papillary to middle dermis, without vascular proliferation, and a decrease of melanin content in the epidermis. These histopathologic features are consistent with the white, nodular, dermoscopic appearance.

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