Skin-Colored Papules on the Neck of a Postmenopausal Woman: A Diagnostic Challenge

A 64-year-old patient presented for management of symptomatic skin-colored papules symmetrically distributed over the lateral neck over the past two years, which failed to improve on multiple topical corticosteroids, antifungal creams, and topical calcineurin inhibitor. Histopathologic examination showed a regular epidermis with increased melanophages in the papillary dermis, without vacuolar degeneration of the basement membrane. Verhoeff Van Gieson stain highlighted a band-like zone of attenuated elastic fibers in the papillary dermis, while Von Kossa stain was negative for calcified fibers. PAS staining was negative for fungal organisms and Alcian blue showed no increase in dermal mucin.