Asymptomatic, Tiny Yellowish Papules on the Back of the Wrist: Challenge

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A 67-year-old white woman with a history of liver transplantation due to alcohol-induced and drug-induced cirrhosis presented with a few asymptomatic, tiny, slightly yellowish papules on the back of her right wrist (Fig. 1). The patient reported that the lesions had been present for approximately 4 months. The surrounding skin showed signs of severe sun damage. The rest of the dermatological examination was unremarkable. Her oral medications included tacrolimus, mycophenolate mofetil, prednisolone, ursodeoxycholic acid, as well as iron supplement and acetylsalicylic acid.
A 4-mm punch biopsy was taken. Histological examination revealed an atrophic epidermis with loss of rete ridges. In the dermis there was a well-circumscribed, broad mass of amorphous, basophilic elastotic material with deposition of mucin and proliferation of fibroblasts (Fig. 2). A thin subepidermal grenz zone of nonaffected dermis was observed. The deeper dermis did not show any pathological findings.
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