A healthy 14-year-old boy with no prior medical problems developed a pale, firm umbilicated papule with a central crust on his left cheek. Thelesion remained unchanged for 1 year. However, over the next 6 months, numerous firm, skin-colored to violaceous umbilicated papules developed over the patient'sentire face (Figure 1). Collections of new papules simultaneously appeared, some in an annular pattern, on thesubmental area (Figure 2), upper part of the back, nape, extensor surface of the left forearm, knees, and distalaspect of the lower extremities. A biopsy specimen was obtained from a lesion on the lower left cheek area (Figure 3 and Figure 4).
Fuller BW, Binnick A, Baughman R, Dinulos JGH. Progressive Diffuse Papules in a Child—Quiz Case. Arch Dermatol. 2004;140(7):877-882. doi:10.1001/archderm.140.7.877-g