A Pseudoxanthoma Elasticum–Like Papular Eruption: Challenge
A 73-year-old white woman presented with a 15 years history of an asymptomatic pseudoxanthoma elasticum–like papular eruption. Her medical history was notable for breast adenocarcinoma and papillary thyroid carcinoma treated with radioactive iodine. She was being controlled by diabetes mellitus, hypertension, and hypercholesterolemia. The physical examination revealed multiple, white yellowish, firm, 2-mm to 4-mm, non-follicular papules, symmetrically distributed, on the lateral aspects of the neck, supraclavicular, and humeral region (Fig. 1), antecubital fossa, volar forearms, thighs, and popliteal fossa (Fig. 2). In the neck, some lesions tended to coalesce, forming a cobblestone pattern. A biopsy of a papule from thigh was performed, and the histopathological examination showed a thickening of the collagen bundles in the reticular dermis (Fig. 3). The orcein staining demonstrated an increase of elastic fibers in the reticular dermis (Fig. 4).