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What Are These Multiple Brown Macules and Papules in an 11-Month-Old Boy?

Natalia Guerra, BS1 • Michelle Gallagher, DO2

    1College of Osteopathic Medicine, Michigan State University, East Lansing, MI
    2Assistant Professor, Department of Pediatrics, College of Osteopathic Medicine, Michigan State University, East Lansing, MI

    Guerra N, Gallagher M. What are these multiple brown macules and papules in an 11-month-old boy? Consultant. 2023;63(8):e1. doi:10.25270/con.2023.07.000003

    Received November 8, 2022. Accepted March 17, 2023. Published online July 31, 2023.

    The authors report no relevant financial relationships.


    Natalia Guerra, BS, 3439 Woodward Ave, Detroit, MI 48201 (

    An 11-month-old boy was brought into the clinic by his mother for evaluation of multiple widespread tan-brown macules and papules located on the infant’s back and chest (Figure 1).


    Figure 1. Multiple tan macules and papules on the infant’s back.

    History. The lesions had been present for approximately 7 months and had not been treated or evaluated previously. His mother reported that no at-home treatments, including topical ointments and creams, had improved or worsened the lesions and they were not triggered by any environmental stimuli. New lesions continued to appear, and all were asymptomatic without itch or pain. The patient had no significant past medical history or allergies. A physical examination showed numerous 1 to 3 mm light brown-tan macules and slightly raised papules on the back and chest.

    Diagnostic testing. One of the lesions was lightly scratched with the wood-end of a cotton swab. After several minutes, the scratched lesion became itchy and erythematous, and wheal formation was observed. These findings were consistent with Darier sign (Figure 2).

    Figure 2. Positive Darier sign.


    Answer and discussion on the next page. 


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