Nonfollicular papules in the bilateral inframammary region

BACKGROUNDA 56-year-old female with a history of diabetes, hypertension, and hyperlipidemia presents with a 6 month history of rash under bilateral breasts for which treatment with nystatin powder and ketoconazole cream demonstrated no improvement.On examination, loose atrophic skin and white-to-yellow nonfollicular papules coalescing into plaques in the bilateral inframammary region with incomplete involvement of the folds were observed (Fig 1).A punch biopsy of the area showed degeneration and fragmentation of elastic fibers (Fig 2).Verhoeff e Van Gieson (VVG) staining confirmed the near absence of elastic fibers within the papillary dermis (Fig 3).