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July 21, 2008

Multiple Facial Papules and Palmar Pits—Quiz Case

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Arch Dermatol. 2008;144(7):933-938. doi:10.1001/archderm.144.7.933-d

A 73-year-old white woman presented with a 10- to 15-year history of countless small papules on her nose, nasolabial folds, lips, and chin. She reported that her sister, as well as her mother, had presented with similar papules in their fifties. Her mother had a history of her skin “pricking” instead of sweating, and the patient described herself as “not sweating easily.” Her grandmother had rheumatoid arthritis, and her mother had arthritis of unknown etiology. There is no other known family history of autoimmune disorders, and her only brother was unaffected. A physical examination revealed hundreds of nontender, round, skin-colored to whitish 2- to 4-mm papules (Figure 1). She had many small 1- to 2-mm shallow pits on her palms. Scars were evident from prior treatment of several lesions. Shave biopsy specimens were obtained from the patient's chin for microscopic examination (Figure 2 and Figure 3).

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