Multiple Firm Papules on the Wrists and Forearms

A 69-year-old woman presented to the dermatology department with persistent asymptomatic skin lesions on the wrists and forearms of several months' duration.The lesions had slowly grown in number over the past few months with no identifiable triggers.The patient reported no known history of injury or trauma to the affected sites and was not taking any prescription medications other than daily vitamins.She denied any family history of similar lesions and was otherwise healthy.Physical examination revealed multiple waxy, firm, hypopigmented, 3-to 5-mm papules located exclusively on the dorsal wrists and forearms.No extracutaneous involvement was observed.A 4-mm punch biopsy from the forearm was obtained. THE BEST DIAGNOSIS IS:a. acral persistent papular