A 10-month-old African American boy with no significant medical history was brought to the dermatology office by his mother with multiple,
widespread brown papules. At birth, approximately 3 lesions were present on the boy's face, arm, and back. They were described as brown-black lesions, less than 1 cm in size, with a smooth texture. Over time,
more lesions began appearing, spreading to the rest of the trunk and the extremities. There was no associated pruritus, diarrhea, nausea,
vomiting, irritability, flushing, dyspnea, or abdominal pain. Over-the-counter topical treatments, including corticosteroids, provided no relief.
The family history was significant for the eldest son with atopic dermatitis. The physical examination revealed multiple, widespread brown-black papules scattered on the trunk and extremities (Figure 1). A skin biopsy specimen was obtained from a papule on the boy's back. An increased number of mast cells in the upper dermis was noted on microscopic examination (Figure 2).