Translucent and Hyperpigmented Papules and Nodules on the Upper Back and Neck

Presenter: Stephen Mallette DO, Alpesh Desai DO
Dermatology Program: Western University College of Osteopathic Medicine of the Pacific
Program Director: David C. Horowitz DO, Mark K. Horowitz DO
Submitted on: Jul 29, 2002

CHIEF COMPLAINT:  Painless papules on the upper back for three months, which are increasing in size and number.

CLINICAL HISTORY:

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.

 

 

 

 

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:

1.   Amyloidosis
2.   Lichen myxedematosus
3.   Hypertrophic lichen planus
4.   Nodular urticaria pigmentosa


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