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August 2009

Annular and Keratotic Papules and Plaques in a Teenager—Quiz Case

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Arch Dermatol. 2009;145(8):931-936. doi:10.1001/archdermatol.2009.151-a

A 14-year-old adolescent white boy presented with asymptomatic erythematous papules and plaques on his face, neck, and arms. The facial lesions began as red papules that had progressively enlarged over the last 2 years. The patient admitted having a habit of scratching the lesions. Previous treatment included clobetasol propionate ointment, 0.05%, and intralesional triamcinolone, 20 mg/1 mL, neither of which improved the eruption. His medical history was not remarkable for Down syndrome, joint hypermobility, or other connective tissue disorders. Findings from physical examination showed erythematous, keratotic papules on the surface of the face, neck, and forearms and larger erythematous plaques with a rim of keratotic papules surrounding a slightly atrophic center near the angle of the right jaw (Figure 1). Punch biopsies of a representative plaque and papule on the face and forearm, respectively, were performed (Figure 2). A Verhoeff–van Gieson stain was used to highlight degenerate elastic tissue at the base of the lesion (Figure 3).

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