Papular Lesions on the Forearms in a 56-Year-Old Woman

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Öner S., Avcı C., Lebe B.

JAAD CASE REPORTS, vol.66, no.December 2025, pp.1-3, 2025 (Scopus)

• Publication Type: Article / Case Report
• Volume: 66 Issue: December 2025
• Publication Date: 2025
• Doi Number: 10.1016/j.jdcr.2025.08.037
• Journal Name: JAAD CASE REPORTS
• Journal Indexes: Scopus, EMBASE, Directory of Open Access Journals, PubMed
• Page Numbers: pp.1-3
• Open Archive Collection: AVESIS Open Access Collection
• Dokuz Eylül University Affiliated: Yes

Abstract

CASE DESCRIPTION

A 56-year-old woman presented with a 4-y history of persistent, asymptomatic papules symmetrically located

on the dorsum of her hands and distal forearms (Fig 1). There was no history of trauma, systemic illness, or

medication use. Her personal and family history were noncontributory. Dermatologic examination revealed

numerous 2-5 mm, firm, dome-shaped, flesh-colored papules without inflammation or secondary changes (Figs

2 and 3). A punch biopsy demonstrated orthokeratotic epidermis with prominent mucinous degeneration in the

superficial dermis separating collagen bundles without fibroblast proliferation (Fig 4). Histochemical staining

with Alcian blue was positive for mucin. Special stains, including Congo red, crystal violet, PAS, and elastic tissue

stain, were negative for amyloid, fungi, and elastic fiber alterations.

Question: Which of the following is the most likely diagnosis?

A. Papular granuloma annulare

B. Discrete papular lichen myxoedematosus

C. Acral persistent papular mucinosis

D. Eruptive xanthomas

E. Papular sarcoidosis