PMC9309296_01
Multiple, skin-colored papules on face (The red arrows mark several of these typical papules). Near the left corner of the mouth, there are 2 red follicular papules (diagnosed as acne) (A1 and A2). Normal epidermis with slight fibrosis in the dermis (B) (H&E, 40x). Patchy loss of elastic fibers throughout the dermis with no correlation to hair follicles (C) (Verhoeff-Van Gieson, 40x). Prominent elastic fragmentation (D) (Verhoeff-Van Gieson, 400x). Focal hyperplasia of collagen bundles in the mid-dermis (E) (Masson staining, 40x).
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Dermatological examination revealed multiple, nonfollicular, skin-colored, discrete papules on the mandibular regions, nose, cheeks, and forehead (Figure 1A1 and A2). Skin biopsy revealed unremarkable changes in epidermis and slight fibrosis in the dermis on hematoxylin and eosin staining (Figure 1B). Elastin staining (Verhoeff-Van Gieson) revealed patchy loss and prominent fragmentation of elastic fibers throughout the dermis (Figure 1C and D). Focal collagen hyperplasia was found on Masson staining (Figure 1E).