Translucent and Hyperpigmented Papules and Nodules on the Upper Back and Neck

Presenter: Stephen Mallette DO, Alpesh Desai DO

Dermatology Program: Western University College of Osteopathic Medicine of the Pacific

Program Director: David C. Horowitz DO, Mark K. Horowitz DO

Submitted on: Jul 29, 2002

CHIEF COMPLAINT: Painless papules on the upper back for three months, which are increasing in size and number.

CLINICAL HISTORY: The patient reports that the lesions on her upper back and neck are non-tender and have been enlarging slowly over time. She notes that new lesions continue to appear, but there is no associated pruritus or discharge. In terms of previous treatment, she has tried topical steroids, topical antibiotics, and oral antibiotics, but these interventions have not resolved the issue. The patient’s medical history is significant for dialysis, which she has been receiving since 1999, and she has a fistula located on her left forearm. Additionally, she moved to the United States from Nigeria in 1997.

PHYSICAL EXAM:
The patient is a well-nourished African American female in no acute distress. Multiple, hyperpigmented, waxy 2-mm to 4-mm dome-shaped and flat-topped papules located on the upper back and neck. Some of these lesions are arranged in parallel rows. There are also larger, thick, deeply pigmented nodules of irregular size and shapes on the back of the neck. These lesions were non-tender. There were no signs of infection. An AV fistula was noted on the left forearm. No other lesions were noted.