Presenter: Roger C. Byrd D.O., David R. Byrd M.D. and Mark Hinkson D.O

Dermatology Program: St. John Oakland, Madison Heights, MI

Program Director: Anthony Cardellio, D.O.

Submitted on: February 28, 2003

CHIEF COMPLAINT: Multiple papules on her cheeks and nose

CLINICAL HISTORY: A 73-year-old Caucasian female was seen about a year ago for evaluation of multiple papules on her cheeks and nose. The lesions are asymptomatic but have gradually increased in number since the time of menopause. The patient’s mother and sisters have similar lesions on their faces, which also started around menopause. However, 4 daughters are currently unaffected by this process. The patient’s past surgical history includes colonoscopy, left breast lumpectomy, and removal of kidney stone. Her medications include Fosamax and Premarin. Her past dermatologic history includes treatment of actinic and seborrheic keratoses.

PHYSICAL EXAM:
The patient presents with multiple 1-3 mm flesh-colored papules of the cheeks and nose.

LABORATORY TESTS: N/A

DERMATOHISTOPATHOLOGY:

A skin biopsy from July 2002 showed a dilated hair follicle surrounded by thickening of fibrous connective tissue on a background of actinic elastosis and telangiectasia in the dermis, consistent with perifollicular fibroma.

DIFFERENTIAL DIAGNOSIS:

1.   Multiple trichoepithelioma
2.   Angiofibromas
3.   Birt-Hogg-Dube Syndrome
4.   Apocrine hidrocystomas