A 53-year-old white woman presented with white papules on her neck of over 10-years duration. These papules were numerous, 2 to 3 mm in diameter, clearly marginated, asymptomatic, and unrelated to the hair follicles (Fig, 1), There was no family history of a similar skin condition and the patient had no underlying illness.On histologic examination, the epidermis was slightly atrophic. There was thickening of the collagen bundles in the papillary dermis and slight paucity of elastic fibers (Fig, 2), This clinical and histologic picture suggested the diagnosis of "white fibrous papulosis of the neck" (WFPN).
Electron Microscopy:Deparaffined skin samples of the WFPN patient were processed with conventional and unconventional procedures for ultrastructural analysis,''The papillary dermis was characterized by very compact and rugged collagen bundles (Fig, 3); in some of these, twisted and laterally fused fibrils were visible (Fig, 4), A large amount of matrix proteoglycans (PGS) was revealed by cytochemical methods in the same areas of the dermis. The PGS appeared as long and multibranched filaments among cells, collagen, and elastin fibers (Fig, 5), Elastin fibers were poorly represented in these same areas; however, by using antihuman alpha-elastin antibodies immunostained with colloidal gold particles (Fig, 6), elastin molecules were revealed that wete associated with very small microfibrillar scaffolding and, surprisingly, also with collagen fibrils, as well as scattered in the soluble matrix.Compared to normal dermis, in the mid-and deep dermis, the collagen bundles appeared smaller than normal, the PGS were scarcely present, and the elastin fibers appeared smaller, fragmented, and cribriform (Fig, 7), A large amount of electron-dense materials, typical of aged elastin, were also visible inside the elastin fibers.
DISCUSSIONIn 1985 Shimizu et al,' described a new clinical entity named "white fibrous papulosis of the neck" (WFI'N).From the
