Progressive Flat Papules on the Extremities: Epidermodysplasia Verruciformis.

During a US military medical mission to Guatemala, a 32-year-old woman with Fitzpatrick skin type IV presented with a chief complaint of numerous white spots on her arms and legs. She had initially noticed a few white spots 25 years earlier, and stated that they had been continuously increasing in number ever since. The lesions were asymptomatic and had not been previously treated; this encounter was the first time she had ever seen a physician. The patient denied any family history of similar-appearing lesions. She was otherwise healthy and was not taking any medications. On examination, she had numerous 3- to 5-mm, well-circumscribed, hypopigmented macules and flat papules scattered on all four extremities (Figures 1 and 2). A full body skin examination revealed no eruptions or similar-appearing lesions elsewhere.