Red scaly lesions on the neck
Last reviewed: February 2025
Author: Dr Jacqueline du Plessis, Department of Dermatology, John Hunter Hospital, Australia (2025) and Dr Ian Coulson, Dermatologist, Burnley, United Kingdom (2025).
Edited by the DermNet content department
Background
This 23-year-old man has a 3-year-history of these lesions on his neck. He is concerned about the appearance as well as the rough feel of the lesions.
Describe what you see.
There are red scaly papules arranged both in an annular and a snake-like distribution on the neck.
What is the diagnosis?
What would you find on histopathology?
Histology shows coarse elastic fibres perforating the epidermis, causing focal epidermal hyperplasia. There is a marked increase in elastic fibres in both dermal layers, with thickened, vertically-oriented fibres in the papillary dermis.
The lesion centre demonstrates transepithelial, parafollicular, or transfollicular perforation of elastic fibres, which may appear straight, wavy, or screw-like. The dermis at the site of perforation often contains lymphocytes, macrophages, and multinucleated giant cells, with a common foreign body giant cell reaction and occasional elastophagocytosis.
With what underlying conditions may it be associated?
- Down syndrome
- Ehlers-Danlos syndrome
- Osteogenesis imperfecta
- Marfan syndrome
- Pseudoxanthoma elasticum
- Rothmund-Thomson syndrome
- Acrogeria
- Can also be associated with long-term use of penicillamine
