A man in his 20s presented with a 6-year history of multiple growing papules superimposed on an asymptomatic firm plaque on the occipital scalp. The lesions were never ulcerated or inflamed, but hemorrhage occurred occasionally after rubbing. At 3 years of age, scarlike macules appeared on the occipital scalp and coalesced to form a larger plaque with sparse hair. Simultaneously, multiple brown-red, dome-shaped papules developed on the nose and gradually evolved to involve the cheeks. Rubbery plaques also developed on the sacrococcygeal area, along with hypopigmented patches on the right buttock. The patient has no systemic symptoms or mental impairment and denied a family history of genetic disease.
Wu Q, Chen H, Elston DM. A Firm Plaque on the Occipital Scalp. JAMA Dermatol. Published online July 24, 2019155(9):1071–1072. doi:10.1001/jamadermatol.2019.1972
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