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2017:83:2;274-275
doi: 10.4103/0378-6323.190872
PMID: 27647357

Multiple reddish papules in the bathing trunk distribution

Premanshu Bhushan, Konchok Dorjay
 Department of Dermatology, Dr. PN Behl Skin Institute and School of Dermatology, New Delhi, India

Correspondence Address:
Konchok Dorjay
Dr. PN Behl Skin Institute and School of Dermatology, Greater Kailash-1, New Delhi - 110 048
India
How to cite this article:
Bhushan P, Dorjay K. Multiple reddish papules in the bathing trunk distribution. Indian J Dermatol Venereol Leprol 2017;83:274-275
Copyright: (C)2017 Indian Journal of Dermatology, Venereology, and Leprology

A 20-year-old boy presented with multiple, discrete, 2-4 mm sized, red-purple papules on the arms, trunk, penis, scrotum and legs, becoming confluent around the umbilicus [Figure - 1]. The papules started appearing 3 years ago on his thighs and occasionally bled on trauma, without any other symptoms. The patient had episodic burning pain in both hands and feet, heat intolerance and decreased sweating. There was no history of abdominal pain, bone pain, edema of the feet, auditory or neurological complaints or significant drug intake. No other family member had similar features. Systemic and ophthalmic evaluations revealed no abnormalities.

Figure  1: Multiple, red to purple, hyperkeratotic papules on anterior trunk with grouping around umbilicus

Routine hematological tests, coagulation profile, electrocardiography and chest radiographs were normal. Renal function analysis showed mild proteinuria, up to 0.46 g/L. The α-galactosidase enzyme assay on dried blood spots was 0.55 nmol/h/ml (normal 3–20 nmol/h/ml). Biopsy of a papule showed hyperkeratosis, acanthosis and papillomatosis with dilated and congested vessels, lined by endothelium within dermal papillae [Figure - 2].

Figure  2: Hyperkeratosis of epidermis with acanthosis and papillomatosis, and dilated and congested vessels lined by endothelium in the dermal papillae  (H  and  E, 100)

What Is Your Diagnosis?



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