Woman with hx of alopecia has pruritic, papular rash. Let’s diagnose.

A 32-year-old woman visited her doctor concerned about a rash that developed on her neck and chest 3 months prior. The patient was distressed by its appearance, and experienced mild pruritus, but appeared well and had no systemic symptoms. The patient had a medical history of alopecia areata and Hashimoto thyroiditis.

On examination, numerous follicularly-based, whitish, smooth papules, some confluent, were seen on the upper chest and neck. Histopathologic examination showed epidermal atrophy, vacuolar degeneration at the dermal-epidermal junction, and homogenous hyalinization of the papillary dermis. The patient had no history of dermatological disease or allergies.

What’s the diagnosis?

Use the Differential Builder in VisualDx to help you.

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