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American Academy of Pediatrics
Online-only Article

Visual Diagnosis

13-Year-Old Girl With Pink Papules

Meghan M. Dickman and Ilona J. Frieden
Pediatrics in Review June 2013, 34 (6) e22-e24; DOI: https://doi.org/10.1542/pir.34-6-e22
Meghan M. Dickman
University of California, San Francisco (UCSF), San Francisco, CA.
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Ilona J. Frieden
University of California, San Francisco (UCSF), San Francisco, CA.
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  1. Meghan M. Dickman, MD
  2. Ilona J. Frieden, MD
  1. University of California, San Francisco (UCSF), San Francisco, CA.
  • Author Disclosure

    Dr. Dickman has disclosed no financial relationships relevant to this article. Dr. Frieden has disclosed that she is a dermatology consultant for Pierre Fabre Pharmaceuticals USA. This commentary does not contain discussion of unapproved/investigative use of a commercial product/device.

Presentation:

A 13-year-old girl presents to the clinic with pink papules on her abdomen, legs, arms, and the lateral aspects of her cheeks. The lesions have been present for 4 years, always appearing in the same area, with satellite lesions surrounding the primary site. The rash blanches on palpation. The papules are primarily located on her abdomen and become more prominent and pruritic with sun exposure. The rash is most noticeable in the periumbilical region, where the patient’s metal pants button comes in contact with her skin. The papules are accompanied by pruritus for which she gets mild relief by taking oral antihistamines and applying topical corticosteroids. However, she has been unable to completely get rid of the rash with this regimen.

The patient has an unremarkable medical history and is developing appropriately. There are no similar skin lesions on any close contacts.

On physical examination, the patient has multiple pink papules on the bilateral aspects of her cheeks, upper arms, elbows, knees, and lower legs (Fig 1). All vital signs are within normal limits. There are papules that have coalesced into plaques surrounding her umbilicus (Fig 2), with lichenification. There is evidence of excoriation, without any ulcerations or bleeding. The remainder of the physical examination findings are unremarkable.

Figure 1.

Multiple papules were noted on the arms (left) and legs (right) of the patient.

Figure 2.

The initial location …

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Pediatrics in Review: 34 (6)
Pediatrics in Review
Vol. 34, Issue 6
1 Jun 2013
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Visual Diagnosis
Meghan M. Dickman, Ilona J. Frieden
Pediatrics in Review Jun 2013, 34 (6) e22-e24; DOI: 10.1542/pir.34-6-e22

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Visual Diagnosis
Meghan M. Dickman, Ilona J. Frieden
Pediatrics in Review Jun 2013, 34 (6) e22-e24; DOI: 10.1542/pir.34-6-e22
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