Sir,

White fibrous papulosis of the neck (WFPN) is a rare acquired fibroelastolytic disorder characterized by the appearance of firm, persistent, usually asymptomatic, non-follicular papules located on the neck yet also on the back, without associated systemic manifestations. The first case reported dates back to 1983 in Japan [1]. The pathogenesis remains unknown yet seems to be related to intrinsic skin photoaging, yet is probably multifactorial; its clinical course is benign [2]. The main differential diagnosis of this entity is pseudoxanthoma elasticum associated with systemic complications. Herein, we report the case of an elderly woman who presented this entity.

A 69-year-old woman presented with a several-month history of multiple asymptomatic cutaneous lesions on both sides of the neck. A physical examination revealed multiple papular lesions measuring 2 to 4 mm in diameter, skin-colored, round to oval, clearly marginated, and unrelated to the hair follicles (Fig. 1). She did not have any symptoms suggestive of vascular, gastro-intestinal, and ocular disorders; they were absent in other family members as well. Physical examination, including peripheral pulses and cardiovascular evaluation, was normal. A cutaneous biopsy revealed a normoacanthosic epidermis with orthokeratosis, thickened collagen bundles in the papillar dermis objectified by Masson’s trichrome stain (Fig. 2a). Orcein staining showed slightly decreased, unfragmented, non-calcified elastic fibers (Fig. 2b).

	Figure 1: Multiple papular lesions, skin-colored, non-follicular, round to oval, located on the neck.
	Figure 2: (a) Thickened collagen bundles in the papillar dermis objectified by Masson’s trichrome stain. (b) Orcein staining showing slightly decreased, unfragmented, non-calcified elastic fibers.

Based on these findings, the diagnosis of white fibrous papulosis of the neck was confirmed. The patient did not request cosmetic treatment and remains stable after six months of follow-up.

WFPN is a rare entity with a characteristic clinical and histological picture and unknown pathogenesis. There are few cases reported to date, thus the publication of new cases is of prime interest. We reported this case to bring attention to this cosmetically undesirable condition and its differential diagnosis.

REFERENCES

1.Shimizu H, Kimura S, Harada T, Nishikawa T. White fibrous papulosis of the neck:A new clinicopathologic entity?J Am Acad Dermatol. 1989;20:1073-7.

2.Rios-Gomez M, Ramos-Garibay JA, Perez-Santana ME, Rostro-Hernandez MA, Aguilera-Martinez V. White fibrous papulosis of the neck:A case report. Cureus. 2022;14:25661.