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December 2009

Multiple Comedonelike Lesions Encircling the Anal Orifice—Quiz Case

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Arch Dermatol. 2009;145(12):1447-1452. doi:10.1001/archdermatol.2009.289-a

An 84-year-old man presented with pruritus localized to the extremities. At admission, routine physical examination revealed the presence of multiple comedonelike lesions encircling the anal orifice (Figure 1). The surrounding skin and anal mucosa were normal. The patient denied having congenital, recent, or past anal and perianal pathologic conditions and specifically denied having pruritus in this area. He had never made use of local topical treatments, such as corticosteroid-based creams or laxatives and suppositories of any type, including mineral oil–based ones. The findings of a detailed gastrointestinal tract history taking were unremarkable, and the patient had never had acne except for a very mild case on the face during adolescence. The patient, currently retired, had never worked with or been exposed to comedogenic substances. Family history was noncontributory. A biopsy of the perianal skin was performed (Figure 2 and Figure 3).