Fleshy Lesions on a 32-Year-Old Woman

Alyssa Abbey, MCMS, PA-C; Martin I. Newman, MD

Disclosures

November 11, 2014

Editor's Note: The Case Challenge series includes difficult-to-diagnose conditions, some of which are not frequently encountered by most clinicians but are nonetheless important to accurately recognize. Test your diagnostic and treatment skills using the following patient scenario and corresponding questions.

Background

A 32-year-old woman presents to the emergency department with several flesh-colored papules on her face, trunk, and upper extremities (Figure).

She first noticed the lesions at approximately 10 years of age; however, over the past 5 years, the lesions have increased in number and have become uncomfortable. She primarily complains of irritation from the lesions along her bra line. She underwent excision of similar skin lesions 5 years ago, but they have since recurred. She denies having any discharge, pain, trauma, contact with individuals with atypical skin lesions or rashes, travel out of the country, unusual exposure to animals, or a history of sexually transmitted diseases.

The patient's medical and surgical history includes environmental allergies, frequent episodes of bronchitis, and the aforementioned excisions. She has no known drug allergies, and she takes cetirizine hydrochloride and fluticasone propionate for seasonal allergies. Her family history is significant for coronary artery disease, hypertension, diabetes mellitus, and glaucoma, but no family history of similar lesions is reported. She does not smoke and drinks alcohol only occasionally. The review of her systems is otherwise unremarkable.

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