History Figure 1 A 47-year old white woman presented complaining of "bumps" of her face and thighs. The lesions had been present for at least 20 years and were asymptomatic. She noted that she had a daughter with similar lesions of the face and thighs. She was otherwise healthy and had no other known medical problems Physical examination revealed numerous skin-colored, firm, smooth, dome-shaped papules ranging in size from 2 to 4 mm on the nose, cheeks, and forehead. Numerous 3 to 8 mm softer, brownish papules, most of which were pedunculated, were present on both medial, proximal thighs.

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Figure 2: Dome shaped papules on the cheek Figure 3: Skin tags on the proximal medial thighs.

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Figures 4: Histopathology of skin papule demonstrates basophilic stoma around the distorted hair follicle and strands of basiloid cells extending from the basal layer of the hair follicle into the stroma. Figure 5: Higher power magnification of basaloid cells and surrounding fibrotic stroma.

ANSWER: What is your diagnosis?