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June 2006

Disseminated White Papules—Quiz Case

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Arch Dermatol. 2006;142(6):775-780. doi:10.1001/archderm.142.6.775-c

A 26-year-old woman with short stature and a wide face presented with a 3-year history of asymptomatic, slowly progressing grain-sized papules involving her whole trunk, neck, face, and all 4 extremities. She also had an 8-year history of chronic generalized eczema, recurrent sinopulmonary infections, and cellulitis, resulting in facial pyoderma and damage of the nasal cartilage. Her family history was unremarkable.

Physical examination revealed miliary, smooth, yellowish to white papules ranging from 1 to 5 mm in diameter (Figure 1 and Figure 2). Lichenified plaques with excoriation were observed on the distal aspect of all 4 extremities. Initial investigations included a complete blood cell count, determination of serum IgE levels, and an anti–human immunodeficiency virus antibody assay. A skin biopsy specimen was obtained from the abdomen (Figure 3).

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