A 4.5-year-old black boy was referred to the pediatric dermatology clinic for evaluation of numerous, slightly pruritic papules distributed on the face and neck and the upper aspects of the chest and back. The papules erupted initially on the face approximately 1 year before our evaluation; over the ensuing year, they had developed on the neck and the upper aspect of the trunk. The child had a history of infantile atopic dermatitis but was otherwise healthy. Family history was notable for eczema and asthma in several maternal family members.The papular eruption had been treated with various low-to high-potency steroid ointments, antifungal creams, systemic corticosteroids, and antibiotics. With the exception of transient resolution during a course of prednisone therapy, the eruption was refractory to treatment.Examination showed numerous infiltrated papules, skintone to erythematous, ranging in size from 1 to 4 mm, located in the infraorbital areas, periorally, on the posterior and lateral aspects of the neck, and on the upper aspect of the trunk (Figs 1 through 3). No pustules were present. The remainder of the skin and physical examination showed normal findings.A punch biopsy specimen was obtained from a papule on the neck (Fig 4).