, Corinna Eleni Psomadakis2 and Bobby Buka3
(1)
Department of Family Medicine, Mount Sinai School of Medicine Attending Mount Sinai Doctors/Beth Israel Medical Group-Williamsburg, Brooklyn, NY, USA
(2)
School of Medicine Imperial College London, London, UK
(3)
Department of Dermatology, Mount Sinai School of Medicine, New York, NY, USA
Keywords
Juxtaclavicular beaded linesPapuleSebaceous glandHyperplasiaHyperkeratosisVellus hairAndrogen
Fig. 23.1
Curvilinear pink or flesh-toned papules that follow Blashko Lines
Fig. 23.2
This benign finding must be asymptomatic or look for another diagnosis
Primary Care Visit Report
A 26-year-old male with no past medical history presented with “lines” around his neck that he had had for a few weeks. They were not itchy and he was otherwise feeling well.
Vital were normal. On exam, his bilateral lateral neck and supraclavicular area featured a very fine linear yellow papular rash with normal skin in between the linear lines of rash. There was no scale and no erythema.
Unsure what this was, I prescribed a trial of topical mometasone 0.1 % daily and asked the patient to follow up in 1 week.
One week later, there was no change in the rash. I switched the patient to topical clotrimazole 1 % twice daily .
Four weeks later, the patient reported no change in the rash. I advised the patient to try 40 % urea cream and/or to get a dermatology evaluation. The rash did not bother the patient, and he declined further treatment.
Discussion from Dermatology Clinic
Differential Dx
Juxtaclavicular beaded lines
Pseudoxanthoma elasticum
Papular mucinosis
Flat warts
Molluscum contagiosum
Favored Dx
Juxtaclavicular beaded lines are favored in this case. The linear arrangement and yellow color of the papules are indicators. Additionally, treatment with topical steroid and antifungal had no effect, which weakens the case for an inflammatory, or a fungal condition.
Overview
Juxtaclavicular beaded lines (JCBL) are a rare form of sebaceous gland hyperplasia that occurs adjacent to the clavicle. The condition is characterized by small yellow papules arranged in parallel lines, resembling strands of beads.
JCBLs generally appear in the second to fifth decades of life, and they are more common among African Americans [1]. There is a slight female predominance [2]. Etiological factors linked to the condition include hormones, corticosteroid use, and eruptions resembling acne. JCBLs often appear during puberty when increased androgen production begins [2]. Long-term topical or systemic corticosteroid use has been associated with the lesions, as the steroids have an effect on androgen levels [2].
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