A 54-year-old white man presented with an 8-month history of multiple asymptomatic lesions on his chest. His medical history was significant for chronic ischemia in both legs that had required a bilateral femoropopliteal bypass 3 years earlier. He was on a long-term regimen of aspirin and ticlopidine hydrochloride to prevent a recurrence of the ischemia. He had also been taking diazepam and paroxetine for 5 years for an emotional disorder. He was otherwise asymptomatic.
Physical examination revealed several flesh-colored, translucent, tender, cystlike papules, measuring 1- to 5-mm in diameter, grouped in clusters localized on the patient’s chest. Some of them were larger and appeared to contain fluid (Figure 1). Laboratory investigations, including a serum chemistry panel, liver function tests, complete blood cell count, erythrocyte sedimentation rate, urinalysis, and determination of serum thyroid-stimulating hormone and total and free thyroxine levels, revealed no abnormalities. Serologic tests were negative for antinuclear, antiperoxidase, and anti-Ro antibodies. A biopsy specimen was obtained from one of the papules and stained with hematoxylin-eosin (Figure 2) and alcian blue (Figure 3).