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BACKGROUND
A 32-year-old woman presents to the emergency department with several flesh-colored papules on her face, trunk, and upper extremities. She noticed the lesions at approximately 10 years of age. However, over the past 5 years, the lesions have increased in number and become uncomfortable. She primarily complains of irritation from the lesions along her bra line. She previously underwent excision of other similar skin lesions 5 years ago, but these have since recurred. She denies having 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 disease.
The patient's medical and surgical history includes environmental allergies, frequent episodes of bronchitis, and the aforementioned excisions. She takes cetirizine HCl (Zyrtec) and fluticasone propionate (Flonase) for allergies and has no known drug allergies. Her family history is significant for coronary artery disease, hypertension, diabetes mellitus, and glaucoma. She does not smoke and drinks alcohol on occasion. The review of systems is otherwise noncontributory.
Physical examination reveals dozens of fleshy nodules of 0.5-2.0 cm throughout her trunk, face, and upper extremities. The nodules are nontender to palpation and nonerythematous, and they produce no discharge, crusting, or scaling. Several 1.5- to 3-cm, tan, oval macules and patches with well-defined borders are located on her trunk and upper extremities (see Images). Her vital signs are within normal limits, and the rest of the physical findings are unremarkable.
What is the diagnosis?
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Hint
Tan macules or patches, known as "café au lait" spots, are characteristic of this genetic disorder. |
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Author:
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Alyssa D. Abbey, BA, PA-S,
Physician Assistant Student,
Barry University-Miami Shores, Fla
Martin I. Newman, MD,
Department of Plastic and Reconstructive Surgery,
Cleveland Clinic Florida, Weston |
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eMedicine
Editor:
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Erik D. Schraga, MD,
Staff Physician,
Kaiser Permanente,
Santa Clara Medical Center, Calif
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