Since they appeared in early childhood, the lesions on this 50-year-old woman’s arms have waxed and waned, becoming most noticeable in the winter. Although they are generally asymptomatic, the patient is bothered by their rough feel. She admits to picking at them, which causes further irritation. Moisturizers have provided some (temporary) relief.
The patient’s mother and sister have similar lesions, as well as very sensitive skin that overreacts to contactants. The entire family is markedly atopic, with seasonal allergies, asthma, and eczema.
The bumps can be seen on the deltoids, triceps, back, and anterior thighs but are particularly prominent on a small area of skin on the patient’s left triceps. The posterior third of both cheeks, which are faintly red, is mildly affected. Overall, glabrous (nonhairy) areas are completely spared.
The individual papules are hyperkeratotic, measure a millimeter or less, and are follicular. Many are faintly erythematous; when picked away, several reveal a coiled hair inside the papule.
What is the diagnosis?