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Translucent and Hyperpigmented Papules
and Nodules on the Upper Back and Neck
Western University College of Osteopathic Medicine of the Pacific,
Coast Dermatology
Torrance, CA
July, 2002
Presenters:
Stephen G. Mallette, DO (Resident),
Alpesh Desai, DO (Resident)
Program
Director: David C. Horowitz, DO, FACD, Mark K. Horowitz, DO
Clinical Presentation
Patient: 54 years old African American Female
History
Chief Complaint: Painless papules on the upper back for
three months, which are increasing in size and number.
Signs and symptoms: The patient states that lesions are
non-tender and have enlarged slowly over time. The patient also states
that new lesions also occur over time. There is no pruritus or discharge
from the lesions. They occur only on the upper back and neck.
Previous Treatment: Topical steroids, topical antibiotic
and oral
antibiotics.
Other Information: The patient has been receiving dialysis
since 1999 and has a fistula located on her left forearm. The patient
moved to the United
States from Nigeria in 1997.
Physical Exam
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.
Figure 1 to Figure 4. (click image to zoom)
Laboratory Tests
PTH:
1488.9 (10 - 65)
Calcium:
11 (8.5 - 11)
Total Protein: 8.4 (6.5
- 8)
Albumin
8.2 (3 - 5)
Dermatohistopathology
Microscopic description: Histology showed
increased numbers of fibroblasts and increased mucin in the reticular
dermis.
Differential Diagnosis
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