Dermatology Online Journal

Juxtaclavicular beaded lines: A presentation of sebaceous gland hyperplasia
Adam B Woldow MD, Laura D Houk MD, Faramarz H Samie MD
Dermatology Online Journal 15 (4): 14

Department of Dermatology, Thomas Jefferson University, Philadelphia, Pennsylvania. awoldow@gmail.com

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We write to report a case of juxtaclavicular beaded lines, an infrequently described variant of the normal skin of the neck and clavicular area. Small skin colored to white to yellow brown papules are oriented along Langer lines of tension of the neck, clavicular area, and less commonly the axillae [1]. These 1-2 mm papules occasionally coalesce, however the pattern remains as parallel stippled bands. This pattern can be difficult to appreciate and may become more apparent after briskly rubbing the skin, causing contrasting erythema [2]. The condition is asymptomatic and is not known to be associated with any underlying conditions [1]. Clinicians unaware of the diagnosis may confuse it with pseudoxanthoma elasticum, acanthosis nigricans, pseudoxanthoma-like dermal elastolysis, or papular mucinosis. Juxtaclavicular beaded lines has previously been described primarily in the pediatric population and those receiving topical or systemic steroids [2, 3].

Case report

Figure 1
Figure 1. 56-year-old male with juxtaclavicular beaded lines

A 56-year-old white male presented to our clinic for a routine skin check. Incidentally many closely set skin colored to white papules were noted bilaterally on the lateral neck. The papules measured approximately 2 mm in diameter (Fig. 1). The patient was unaware of the duration of these papules presence and stated that they were asymptomatic. He denied excessive sun exposure and topical or systemic corticosteroid use.

Figure 2
Figure 2. Micrograph of ectopic sebaceous gland hyperplasia (x100)

To confirm the diagnosis, a 4-mm punch biopsy was performed and multiple step sections were examined. The sections were examined by conventional microscopy after being stained with hematoxylin and eosin and elastin stains.

On microscopic examination there was evidence of sebaceous gland hyperplasia and an incidental scar (Fig. 2).

Discussion

This condition was first described by Evan-Paz and Sagher in 1963 as "Cutis Punctata Linearis Colli." It was found in the "v-neck area" of eight patients receiving systemic corticosteroids, of which seven were also taking androgenic steroids [2]. Subsequently, it has been found in 26.2 percent of institutionalized patients with 40 percent of blacks affected in one study and 99 percent of the population of a Spanish hospital's dermatology clinic in another [1, 4].

The condition has been hypothesized to be either a variant of normal or secondary to age, hormone or sun exposure. Butterworth and Johnson's study of institutionalized patients suggested that sun exposure does not play a role [4].

It is our belief that this represents a normal variant, possibly made more pronounced by steroid therapy which results in skin atrophy. As noted by del Rio, 96 percent of the population has a linear arrangement of their folliculo-sebaceous units of either their axilla, neck, or groin [1]. When these sebaceous glands hypertrophy, the beaded line pattern becomes apparent.

The issue of greatest importance with juxtaclavicular beaded lines is that these papules lying across Langer lines of tension may be confused with another diagnosis. The skin toned to white color in our case helped us to differentiate it from acanthosis nigricans which is typically a velvety textured hyperpigmented color, and papular mucinosis which is typically a pale red to yellow color. Histologically, papular mucinosis has abundant acid mucopolysaccharides present in the dermis and an increased number of fibroblasts. Pseudoxantoma elasticum is more yellow in color with histologically evident wider elastic fibers and surrounding calcium deposits [5]. Pseudoxanthoma elasticum-like papillary elastolysis clinically appears similar to pseudoxanthoma elasticum but is found more frequently in elder women and histologically shows a band like loss of elastic tissue in the papillary dermis [6].

References

1. del Río E. Juxtaclavicular beaded lines are a universal condition arranged along tension lines. Dermatol 1998;197:94-95 [PubMed]

2. Even-Paz Z, Sagher F. Cutis punctata linearis colli: Stippled skin. Dermatologica 1963;126:1-12

3. Finan MC, Apgar JT. Juxta-clavicular beaded lines: A subepidermal proliferation of sebaceous gland elements. J Cutan Pathol 1991;18:464-468 [PubMed]

4. Butterworth T, Johnson WC. Juxta-clavicular beaded lines. Arch Dermatol 1974;110:891-893 [PubMed]

5. Donati P, Muscardin, LM, Maini A. Juxtaclavicular beaded lines: A malformative condition affecting sebaceous glands. Dermatol 2000;200:283 [PubMed]

6. Byun JY, Do MO, Kim SH, Choi HY, Myung KB, Choi YW. Pseudoxanthoma elasticum-like papillary dermal elastolysis developed in early middle age. J Dermatol 2007;304:709-711 [PubMed]

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