Race for the Case

Race for the Case is a clinical quiz feature published quarterly in DermWorld Directions in Residency — and right here!

Answer the questions below to enter. Looking for the Summer 2026 answers? Review them now. To submit cases and questions, email Emily Margosian at emargosian@aad.org.

Diagnose this new case by Stephanie Sanchez-Melendez, MD, and Bilal Fawaz, MD, FAAD

A 59-year-old woman with a history of fibromyalgia and chronic migraines presented with a two-year history of pruritic papules on the bilateral neck. Treatment with triamcinolone 0.1% cream for one week provided mild improvement in pruritus but did not resolve the lesions. Review of systems was negative for cardiovascular, gastrointestinal, and visual symptoms.

Physical examination demonstrated numerous skin-colored to yellow papules on the neck, some coalescing into a cobblestone appearance. No similar lesions were present elsewhere on the body or oral mucosa.

Biopsies from the right and left neck demonstrated basket-weave keratosis overlying an unremarkable epidermis, slightly decreased elastic fibers in the papillary dermis on elastic tissue stain, and a mild superficial perivascular and interstitial lymphocytic infiltrate with scattered pigment-laden macrophages.

1. What is the most likely diagnosis?

2. Which histopathologic finding is most characteristic of this condition?

3. Which diagnosis is the most important clinical mimic of this condition?

4. Which histopathologic finding would favor the alternative diagnosis? Which stains would be helpful?

5. What conditions are associated with the inherited disorder that clinically resembles this patient’s condition?

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