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JAMA Dermatology Clinicopathological Challenge
September 2016

Folliculocentric and Octagonal Scaly Papules

Author Affiliations
  • 1Dermatology, US Air Force Hospital Langley, Langley Air Force Base, Hampton, Virginia
  • 2Department of Pathology, Walter Reed National Military Medical Center, Bethesda, Maryland
  • 3Joint Pathology Center, Silver Spring, Maryland
JAMA Dermatol. 2016;152(9):1043-1044. doi:10.1001/jamadermatol.2016.1343

A woman in her 50s with poorly controlled type 2 diabetes and insulin-like growth factor 1 deficiency presented to the dermatology clinc reporting a 1- to 2-year history of continual outbreaks of “flowers” on her skin. The lesions were mildly pruritic and would typically occur in crops of 3 to 4 on the arms, legs, trunk, and buttocks. Individual lesions would last a few months before spontaneously resolving without scarring. The patient denied new or progressively worsening systemic symptoms, including fevers, chills, night sweats, or rapid unexpected weight loss. She had a history of basal cell skin cancer but denied a history of internal cancer, as well as new medications. Pertinent daily medications included metformin hydrochloride, sitagliptin phosphate, insulin glargine, somatostatin, and antihypertensives. Physical examination revealed an obese but otherwise healthy-appearing white woman with multiple small 1.5-cm monomorphic and somewhat octagonal groupings of folliculocentric, erythematous, scaly, and hyperkeratotic papules at different stages of development distributed across arms, legs (Figure, A and B), trunk, and buttocks. Skin examination otherwise had unremarkable results, including normal scalp, palms, soles, and nails, as well as no palpable cervical, axillary, or inguinal lymphadenopathy. Two scoop shave biopsies of representative lesions were performed (Figure, C and D).

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