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April 2007

Keratotic Papules on the Right Side of the Neck and Back—Diagnosis

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Arch Dermatol. 2007;143(4):535-540. doi:10.1001/archderm.143.4.536-a

Microscopic examination revealed epidermal papillomatosis with several foci of suprabasal acantholysis and dyskeratosis as evidenced by corps ronds and grains, with overlying parakeratosis. The patient began daily treatment with 0.025% tretinoin cream.

Darier disease, also known as keratosis follicularis, is an autosomal dominant disorder characterized by (1) warty papules that develop in seborrheic areas, (2) palmoplantar pits, and (3) distinctive nail abnormalities, including alternating red and white longitudinal bands and V-shaped nicking of distal nail plates.1 Approximately 10% of DD cases are segmental, with lesions following dermatomes or lines of Blaschko.2 More than 50 cases of localized DD have been reported, with the disorder variably termed segmental, zosteriform, linear, or unilateral DD.25 The clinical and histologic findings of individual lesions of localized DD are similar to those of individual lesions of generalized DD. Other features of generalized DD, including palmoplantar and nail findings, may be present in localized DD.2 The average age at onset of localized DD is 27 years,3 while patients with generalized DD typically present during puberty. Like generalized DD, localized DD is typically aggravated by sunlight, heat, or sweating.3 Treatment with 0.025% tretinoin cream has been reported to be effective.3

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