What is your diagnosis?
Multiple whitish papules on the posterior neck of an elderly woman
Joana Calvão
, Bárbara Roque Ferreira, José Carlos Cardoso
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"⁎" "correspondencia" => "Corresponding author." ] ] ] ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:7 [ "identificador" => "fig0010" "etiqueta" => "Figure 2" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr2.jpeg" "Alto" => 501 "Ancho" => 750 "Tamanyo" => 60469 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">Multiple small whitish papules on the posterior cervical region.</p>" ] ] ] "textoCompleto" => "<span class="elsevierStyleSections"><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0015">Case report</span><p id="par0005" class="elsevierStylePara elsevierViewall">A 77-year-old woman, who was otherwise healthy, presented with multiple white-yellowish millimetric, monomorphic, non-follicular papules, on the posterior cervical region (<a class="elsevierStyleCrossRefs" href="#fig0005">Figs. 1 and 2</a>). These lesions had been present for several years, and except for mild pruritus, were asymptomatic. Physical examination, including peripheral pulses and cardiovascular evaluation, revealed normal findings. Cutaneous biopsy revealed an ill-defined nodular area in the superficial and mid-reticular dermis, characterized by slight thickening of the collagen fibers and by focally enlarged elastic fibers (<a class="elsevierStyleCrossRef" href="#fig0015">Fig. 3</a>). These findings were highlighted in the Verhoeff-Van Gieson staining, which further showed absence of elastic fibers in the papillary dermis (<a class="elsevierStyleCrossRef" href="#fig0020">Fig. 4</a>). Calcification of elastic tissue was not seen.</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><elsevierMultimedia ident="fig0010"></elsevierMultimedia><elsevierMultimedia ident="fig0015"></elsevierMultimedia><elsevierMultimedia ident="fig0020"></elsevierMultimedia></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0020">Discussion</span><p id="par0010" class="elsevierStylePara elsevierViewall">Clinicopathological correlation favored the hypothesis of white fibrous papulosis of the neck (WFPN). In this context, the authors decided on a watch-and-wait approach; the lesions currently remain stable.</p><p id="par0015" class="elsevierStylePara elsevierViewall">WFPN was first described by Shimizu et al. in 1985. A few years later, the same authors reported this condition in a group of 32 Japanese patients.<a class="elsevierStyleCrossRef" href="#bib0040"><span class="elsevierStyleSup">1</span></a> Although initially reported mainly in Japanese men, it also affects Caucasian women, from the 5th to the 9th decades of life.<a class="elsevierStyleCrossRef" href="#bib0045"><span class="elsevierStyleSup">2</span></a> WFPN is a rare acquired fibroelastolytic disorder, which presents clinically as yellowish-white round or oval papules that occur more frequently on the posterior neck region, but also on the back, without associated systemic manifestations. Its etiopathogenesis, not fully understood, seems to be related to intrinsic skin photoaging, but is probably multifactorial.<a class="elsevierStyleCrossRefs" href="#bib0050"><span class="elsevierStyleSup">3,4</span></a> The clinical relevance of this entity lies in its broad differential diagnosis, especially with pseudoxanthoma elasticum (PXE), a genetic disease caused by a mutation in the ABCC6 (ATP-binding cassette sub-family C member 6) gene and is associated with ectopic mineralization of the skin, eyes, and blood vessels.<a class="elsevierStyleCrossRefs" href="#bib0060"><span class="elsevierStyleSup">5,6</span></a> However, in contrast to the latter, WFPN usually appears late in life, is not associated with systemic complications, and does not require further investigation.<a class="elsevierStyleCrossRef" href="#bib0050"><span class="elsevierStyleSup">3</span></a> Histological examination reveals dermal fibrosis consisting of circumscribed areas of thickened collagen bundles in the papillary and mid-reticular dermis, as well as a variable loss of dermal elastic tissue.<a class="elsevierStyleCrossRefs" href="#bib0050"><span class="elsevierStyleSup">3,6</span></a> Despite its benign nature, WFPN may be cosmetically undesirable and sometimes itchy. Until now, no effective treatments have been established.<a class="elsevierStyleCrossRef" href="#bib0045"><span class="elsevierStyleSup">2</span></a> Some topical agents like tretinoin and antioxidants were tried, but improvement was not notable.<a class="elsevierStyleCrossRefs" href="#bib0045"><span class="elsevierStyleSup">2,7</span></a> Surgical excision may be an alternative choice of treatment in cases with circumscribed lesions.<a class="elsevierStyleCrossRef" href="#bib0045"><span class="elsevierStyleSup">2</span></a> Moreover, since WFPN is arguably a feature of photoaging or intrinsic aging, fractional non-ablative laser has been recently tried with good results.<a class="elsevierStyleCrossRef" href="#bib0045"><span class="elsevierStyleSup">2</span></a> However, none of the treatments present sufficient evidence in the literature.</p></span><span id="sec0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0030">Financial support</span><p id="par0035" class="elsevierStylePara elsevierViewall">None declared.</p></span><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0025">Authors’ contribution</span><p id="par0020" class="elsevierStylePara elsevierViewall">Joana Calvão: Approval of the final version of the manuscript; composition of the manuscript; collection, analysis, and interpretation of data; participation in the design of the study; intellectual participation in the propaedeutic and/or therapeutic conduct of the studied cases; critical review of the literature; critical review of the manuscript.</p><p id="par0025" class="elsevierStylePara elsevierViewall">Bárbara Roque Ferreira: Approval of the final version of the manuscript; collection, analysis, and interpretation of data; participation in the design of the study; critical review of the manuscript.</p><p id="par0030" class="elsevierStylePara elsevierViewall">José Carlos Cardoso: Approval of the final version of the manuscript; conception and planning of the study; collection, analysis, and interpretation of data; critical review of the manuscript.</p></span><span id="sec0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0035">Conflicts of interest</span><p id="par0040" class="elsevierStylePara elsevierViewall">None declared.</p></span></span>" "textoCompletoSecciones" => array:1 [ "secciones" => array:8 [ 0 => array:3 [ "identificador" => "xres1321051" "titulo" => "Abstract" "secciones" => array:1 [ 0 => array:1 [ "identificador" => "abst0005" ] ] ] 1 => array:2 [ "identificador" => "xpalclavsec1218646" "titulo" => "Keywords" ] 2 => array:2 [ "identificador" => "sec0005" "titulo" => "Case report" ] 3 => array:2 [ "identificador" => "sec0010" "titulo" => "Discussion" ] 4 => array:2 [ "identificador" => "sec0020" "titulo" => "Financial support" ] 5 => array:2 [ "identificador" => "sec0015" "titulo" => "Authors’ contribution" ] 6 => array:2 [ "identificador" => "sec0025" "titulo" => "Conflicts of interest" ] 7 => array:1 [ "titulo" => "References" ] ] ] "pdfFichero" => "main.pdf" "tienePdf" => true "fechaRecibido" => "2019-02-18" "fechaAceptado" => "2019-05-19" "PalabrasClave" => array:1 [ "en" => array:1 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Keywords" "identificador" => "xpalclavsec1218646" "palabras" => array:3 [ 0 => "Elastic tissue" 1 => "Neck" 2 => "Pseudoxanthoma elasticum" ] ] ] ] "tieneResumen" => true "resumen" => array:1 [ "en" => array:2 [ "titulo" => "Abstract" "resumen" => "<span id="abst0005" class="elsevierStyleSection elsevierViewall"><p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">White fibrous papulosis of the neck is a rare entity, with fewer than 50 cases described. It is a benign pathology whose main interest lies in its broad differential diagnosis, especially with pseudoxanthoma elasticum. The authors report the case of a 77-year-old woman with multiple yellow-white monomorphic papules on the posterior cervical region, with years of evolution. Cutaneous biopsy revealed a nodular area in the superficial and middle reticular dermis, with slight thickening of the collagen fibers and focally enlarged elastic fibers, aspects highlighted in the Verhoeff staining that additionally showed absence of elastic fibers in the papillary dermis.</p></span>" ] ] "NotaPie" => array:2 [ 0 => array:2 [ "etiqueta" => "☆" "nota" => "<p class="elsevierStyleNotepara" id="npar0005">How to cite this article: Calvão J, Ferreira BR, Cardoso JC. Multiple whitish papules on the posterior neck of an elderly woman. An Bras Dermatol. 2020;95:102–4.</p>" ] 1 => array:2 [ "etiqueta" => "☆☆" "nota" => "<p class="elsevierStyleNotepara" id="npar0010">Study conducted at the Department of Dermatovenereology, Centro Hospitalar e Universitário de Coimbra, Coimbra, Portugal.</p>" ] ] "multimedia" => array:4 [ 0 => array:7 [ "identificador" => "fig0005" "etiqueta" => "Figure 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 692 "Ancho" => 750 "Tamanyo" => 102192 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">Multiple small whitish papules on the posterior cervical region.</p>" ] ] 1 => array:7 [ "identificador" => "fig0010" "etiqueta" => "Figure 2" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr2.jpeg" "Alto" => 501 "Ancho" => 750 "Tamanyo" => 60469 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">Multiple small whitish papules on the posterior cervical region.</p>" ] ] 2 => array:7 [ "identificador" => "fig0015" "etiqueta" => "Figure 3" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr3.jpeg" "Alto" => 561 "Ancho" => 750 "Tamanyo" => 185841 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0020" class="elsevierStyleSimplePara elsevierViewall">Mild solar elastosis and thickening of collagen bundles in the superficial and mid-reticular dermis (Hematoxylin & eosin, ×40).</p>" ] ] 3 => array:7 [ "identificador" => "fig0020" "etiqueta" => "Figure 4" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr4.jpeg" "Alto" => 563 "Ancho" => 750 "Tamanyo" => 215647 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0025" class="elsevierStyleSimplePara elsevierViewall">Thickening of collagen bundles and multifocal coarse thickening of the elastic fibers (Verhoeff, ×200).</p>" ] ] ] "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0015" "bibliografiaReferencia" => array:7 [ 0 => array:3 [ "identificador" => "bib0040" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "White fibrous papulosis of the neck: a new clinicopathologic entity?" 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| Year/Month | Html | Total | |
|---|---|---|---|
| 2024 November | 17 | 8 | 25 |
| 2024 October | 92 | 60 | 152 |
| 2024 September | 122 | 76 | 198 |
| 2024 August | 133 | 86 | 219 |
| 2024 July | 129 | 116 | 245 |
| 2024 June | 90 | 73 | 163 |
| 2024 May | 93 | 61 | 154 |
| 2024 April | 112 | 86 | 198 |
| 2024 March | 94 | 68 | 162 |
| 2024 February | 84 | 79 | 163 |
| 2024 January | 61 | 38 | 99 |
| 2023 December | 58 | 70 | 128 |
| 2023 November | 64 | 75 | 139 |
| 2023 October | 54 | 87 | 141 |
| 2023 September | 62 | 67 | 129 |
| 2023 August | 68 | 36 | 104 |
| 2023 July | 50 | 36 | 86 |
| 2023 June | 56 | 55 | 111 |
| 2023 May | 45 | 32 | 77 |
| 2023 April | 47 | 14 | 61 |
| 2023 March | 59 | 49 | 108 |
| 2023 February | 44 | 29 | 73 |
| 2023 January | 39 | 32 | 71 |
| 2022 December | 46 | 21 | 67 |
| 2022 November | 70 | 59 | 129 |
| 2022 October | 55 | 57 | 112 |
| 2022 September | 44 | 54 | 98 |
| 2022 August | 56 | 39 | 95 |
| 2022 July | 43 | 61 | 104 |
| 2022 June | 51 | 49 | 100 |
| 2022 May | 28 | 46 | 74 |
| 2022 April | 41 | 40 | 81 |
| 2022 March | 41 | 68 | 109 |
| 2022 February | 24 | 35 | 59 |
| 2022 January | 43 | 77 | 120 |
| 2021 December | 32 | 50 | 82 |
| 2021 November | 35 | 56 | 91 |
| 2021 October | 54 | 83 | 137 |
| 2021 September | 30 | 51 | 81 |
| 2021 August | 41 | 58 | 99 |
| 2021 July | 37 | 40 | 77 |
| 2021 June | 35 | 48 | 83 |
| 2021 May | 46 | 78 | 124 |
| 2021 April | 182 | 214 | 396 |
| 2021 March | 52 | 53 | 105 |
| 2021 February | 19 | 21 | 40 |
| 2021 January | 27 | 19 | 46 |
| 2020 December | 20 | 18 | 38 |
| 2020 November | 17 | 10 | 27 |
| 2020 October | 12 | 8 | 20 |
| 2020 September | 9 | 9 | 18 |
| 2020 August | 9 | 10 | 19 |
| 2020 July | 10 | 13 | 23 |
| 2020 June | 16 | 13 | 29 |
| 2020 May | 21 | 11 | 32 |
| 2020 April | 2 | 3 | 5 |
| 2020 March | 11 | 3 | 14 |
| 2020 January | 0 | 6 | 6 |
| 2019 December | 0 | 1 | 1 |
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