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JAMA Dermatology Clinicopathological Challenge
October 2013

Multiple Follicular Papules on the Back of an Elderly Man

Author Affiliations
  • 1University Hospital of Coimbra, Coimbra, Portugal
  • 2St Mary’s Hospital, London, England
  • 3St John’s Institute of Dermatology, London, England
JAMA Dermatol. 2013;149(10):1233-1234. doi:10.1001/jamadermatol.2013.481

A man in his 80s presented with multiple papular lesions, located on the upper back, that were asymptomatic and had been present for approximately 4 to 6 months. The lesions had started after a period in hospital for an orthopedic procedure. There was no other significant medical history, namely, hyperuricemia or any evidence of episodes of gout. Physical examination disclosed multiple follicular relatively monomorphic papules 4 to 6 mm in size each, distributed bilaterally over the upper back and shoulders. Each individual lesion consisted of an erythematous papule containing a central yellowish plug with a waxy appearance (Figure, A). There were no other cutaneous or mucosal lesions and the remaining of his physical examination was normal. A biopsy specimen was taken from 1 of the lesions and stained with hematoxylin-eosin (Figure, B and C).