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June 2007

Multiple Painless Papules on the Wrists—Diagnosis

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Arch Dermatol. 2007;143(6):791-796. doi:10.1001/archderm.143.6.791-h

Hematotoxylin-eosin–stained sections showed a normal epidermis with an accumulation of a substance within the papillary and reticular dermis. This substance stained positive for mucin with alcian blue (pH, 2.5) and periodic acid–Schiff. There was increased spacing between collagen bundles but no increase in fibroblast numbers. There was no subepidermal grenz zone.

The results of laboratory investigations, including a complete blood cell count, erythrocyte sedimentation rate, biochemical profile, thyroid function tests, autoantibody profile, serum protein electrophoresis and immunoelectrophoresis, and fasting cholesterol levels, were all within normal range. Treatment was initiated with a course of incision followed by topical liquid nitrogen, with good response to date.

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