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June 2012

Numerous White Papules on the Vulva—Quiz Case

Author Affiliations

Miller School of Medicine, University of Miami, Miami, Florida (Drs Chen, Spock, and Milikowski); and Comprehensive Dermatology Group, Encinitas, California (Dr Stirling)

Arch Dermatol. 2012;148(6):755-760. doi:10.1001/archdermatol.2012.675a

A 54-year-old woman presented with an approximately 2-year history of lesions in the vulvar area, which had increased in number and had become pruritic over the past several months. She had a history of human immunodeficiency virus (HIV) with a normal CD4 count while receiving triple antiretroviral therapy, as well as a history of cervical dysplasia previously treated and followed by her gynecologist. Her family history was negative for similar lesions. On examination, she had numerous discrete monomorphous white to skin-colored keratotic papules involving her labia majora, proximal medial thighs, perineum, and gluteal cleft (Figure 1). The rest of the findings from her skin examination were normal. A biopsy specimen was taken (Figure 2 and Figure 3).

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