A 42-year-old woman presents with textural changes of the skin on the right side of the neck, which she first noticed 20 years earlier. She is not experiencing any associated pain or pruritus. She reports a medical history significant only for hypertension, which is controlled with valsartan. The patient is not taking any over-the-counter medications, and she does not have a history of tobacco, alcohol, or illicit drug use. Her father and son have unspecified heart disease, and she has never noticed similar cutaneous findings among family members.
Physical examination reveals several grouped, yellow papules with a cobblestone appearance, coalescing to form plaques on the right lateral aspect of the neck (Figures 1 and 2). Deep rhytides are present on the chin and jaw, and she has a horizontal mental crease.
Figures 1 and 2. Yellow papules with cobblestone appearance, coalescing to form plaques on the lateral aspect of the neck.