Presenter: Jason Wilder D.O. Debbie Palmer D.O., Cindy Hoffman D.O., Charles Gropper M.D.

Dermatology Program: St. Barnabas Hospital Dermatology Department, Bronx, New York

Program Director: Cindy Hoffman, DO, FAOCD

Submitted on: May 29, 2002

CHIEF COMPLAINT:  “I have rough skin on my neck that won’t go away.”

CLINICAL HISTORY: A 52 y.o. F with a 20-year history of non-pruritic, gradually developing lesions on her left neck. The patient denies any previous treatment of these lesions. Patient is currently taking Vioxx.

PHYSICAL EXAM:
Multiple, soft, yellow papules coalescing into plaques on the left neck.

LABORATORY TESTS:

Complete Blood Count WNL
Chemistry Profile WNL
Liver Function Tests WNL
Thyroid Function Tests WNL
Lipid Profile WNL
HgbA1c WNL
Erythrocyte Sedimentation Rate 10
Anti-DNA Antibody negative
Antinuclear Antibody negative
Rapid Plasma Reagin nonreactive

DERMATOHISTOPATHOLOGY:

A punch biopsy was performed on the left neck.

Microscopic description: In the middle and lower thirds of the dermis, accumulations of swollen and irregularly clumped elastic fibers with calcium deposition.
An accumulation of slightly basophilic mucoid material is seen.

DIFFERENTIAL DIAGNOSIS:

1.   Xanthomatosis
2.   Cutis Laxa
3.   Ehlers-Danlos
4.   Pseudoxanthoma Elasticum
5.   Papular Mucinosis