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2017:83:4;513-515
doi: 10.4103/ijdvl.IJDVL_432_16
PMID: 28440231

Multiple asymptomatic hard papules on cheeks in an elderly woman

Ram Chander1 , Taru Garg1 , Sarita Sanke1 , Kiran Agarwal2 , Aruna Chhikara2
1 Department of Dermatology and STD, Lady Hardinge Medical College and Associated Hospitals, New Delhi, India
2 Department of Pathology, Lady Hardinge Medical College and Associated Hospitals, New Delhi, India

Correspondence Address:
Sarita Sanke
Department of Dermatology and STD, Lady Hardinge Medical College, Shaheed Bhagat Singh Marg, New Delhi - 110 001
India
How to cite this article:
Chander R, Garg T, Sanke S, Agarwal K, Chhikara A. Multiple asymptomatic hard papules on cheeks in an elderly woman. Indian J Dermatol Venereol Leprol 2017;83:513-515
Copyright: (C)2017 Indian Journal of Dermatology, Venereology, and Leprology

A 55-year-old woman, recently diagnosed with dermatomyositis, presented with multiple, tiny, firm papular lesions on cheeks for many years. These lesions were asymptomatic with no history of ulceration or discharge. Past history was notable for the presence of severe facial acne vulgaris during adolescence and early adulthood. On examination, there were multiple small round to irregular-shaped skin-colored, hard, monomorphic papules on both cheeks [Figure - 1]. There were no similar lesions elsewhere. Patient had characteristic cutaneous manifestations of dermatomyositis - V sign, shawl sign, heliotrope rash, Gottron's sign and holster sign) with proximal muscle weakness.

Figure 1: Multiple, round to irregularly shaped skin colored, monomorphic papules on cheek

Histopathology from the papule showed fibrocollagenous tissue with round to irregular, large homogeneous amorphous basophilic staining deposits in the deep dermis and subcutis. The dermis also showed spicules of crescentic eosinophilic material housing cells held within small lacunae, associated with mature adipose tissue.[Figure - 2],[Figure - 3],[Figure - 4].

Figure 2: Round to irregular, large homogeneous amorphous basophilic staining deposits in the deep dermis and subcutis and spicules of crescentic eosinophilic material (H and E, 10x)
Figure 3: Round to irregular, large homogeneous amorphous basophilic staining deposits in the deep dermis and subcutis and spicules of crescentic eosinophilic material (H and E, ×100)
Figure 4: Crescentic eosinophilic material housing cells held within small lacunae, associated with mature adipose tissue (H and E, ×400)

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