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

## TL;DR

A 64-year-old woman with persistent skin-colored neck papules was diagnosed using histopathology and special stains.

## Contribution

The paper presents a unique case of skin-colored papules with distinct histopathological features not previously described.

## Key findings

- Histopathology showed increased melanophages and attenuated elastic fibers in the papillary dermis.
- No evidence of fungal infection, calcified fibers, or dermal mucin was found.
- The condition did not respond to standard topical treatments.

## Abstract

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.