White Fibrous Papulosis of the Neck

Abstract

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

Acquired disorders of elastic tissue: Part II. decreased elastic tissue

“…White fibrous papulosis of the neck is characterized by multiple (few to 100, usually 10 to 20), asymptomatic, symmetrically distributed, small (2-to 3-mm-diameter), round or oval, nonfollicular, discrete white or pale papules that are typically scattered about the neck (Fig 4). [89][90][91]93 A few cases on the upper third of the trunk have also been reported. 94 Histopathology.…”

“…93 While the main histopathologic change in the dermis is fibrosis consisting of areas of thickened collagen bundles in the papillary and midreticular dermis, loss of elastic tissue in the papillary and reticular dermis has also been noted. 90,91,95,96 In particular, oxytalan and elaunin fibers may be completely absent. 95 Electron microscopy may show a decrease in elastic tissue.…”

“…Patient age has ranged from 39 to 80 (mean, 62) years, suggesting that this disorder affects mostly middle-aged and elderly adults. [90][91][92] Etiology and pathogenesis. The pathogenesis of white fibrous papulosis of the neck is poorly understood, but it has been speculated that it is an intrinsic manifestation of aging.…”

White Fibrous Papulosis of the Neck Treated With Fractionated 1550-nm Erbium Glass Laser: A Case Report

“…3 Thus, we postulated that NAFL may also be effective on WFPN. Fractional 1550-nm Ytterbium/Erbium fiber laser (Finescan ® ; TNC Medditron Co., Ltd., Thailand) using 7-cm tip, with the same recommended parameter for acne scar of 30 mJ/cm 2 White Fibrous Papulosis of the Neck on the testing area of 100 cm 2 along the right chest below the clavicle every 2 weeks for 8 sessions. The patient was anaesthetized using topical lidocaine 2.5% and prilocaine 2.5% cream under occlusion for 45 minutes.…”

“…Nonetheless, several ultrastructural studies suggest that age-or sun-related damages could be indicative factors for WFPN. 2 Particularly, most patients are noted without history of prolonged sun exposure or similar lesions in the same family. More importantly, no effective treatments for WFPN have been established.…”