Back issues No.2 - 2011 / Resident Forum  

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Multiple flesh-colored fi rm papules on the cheeks of an adult woman
Chia-Hung Wei , Hua-En Lee , Lih-Jen Yang

A 68-year-old Chinese woman, without underlying disease, presented
with multiple asymptomatic flesh-colored papules on her
bilateral cheeks for 20 years (Figure 1). She had had a history of
severe acne when she was a teenager. A physical examination
revealed many scattered 2- to 3-mm firm subcutaneous papules
over her bilateral cheeks and forehead. She had received antiacne
topical agents and fractional resurfacing, but there was no significant
improvement. Laboratory results, including complete blood
count, creatinine, calcium, and intact parathyroid hormone were
within normal limits. A skin biopsy was performed, and the histologic
examination showed multiple small pieces of bone with or
without fatty marrow in the dermis (Figure 2). The cortex consisted
of concentric layers of compact bone tissue with multiple lacunae,
which was reminiscent of the Haversian system.

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