Acral Persistent Papular Mucinosis: A New Entity

To the Editor.— Dermal mucinoses are a heterogeneous group of diseases in which an abnormal deposition of mucin occurs in the dermis.1 They are distinguished from the follicular mucinoses in which mucin accumulates within the hair follicles. In dermal mucinoses, either a diffuse infiltration or a focal deposit of mucin may occur. In the latter, papules are the usual clinical presentation. The papular mucinoses (PM), however, are far from a homogeneous grouping of disorders. A variety of clinical presentations have been described both with and without accompanying extracutaneous manifestations. We describe two patients with a persistent progressive eruption of multiple asymptomatic papules that proved to be due to a mucin deposit in the upper reticular dermis. Report of Cases.—Case 1.— A 40-year-old woman was seen for a progressive asymptomatic papular eruption that occurred over the course of two years. On examination, the patient exhibited multiple white papules limited to the extensor surface of her wrists and hands. The papules had a smooth surface and were 2 to 5 mm in diameter. When punctured, they yielded a translucent dense fluid. The patient's thyroid gland was normal in both size and consistency.