A 21-year-old woman presented with a 2-year history of asymptomatic skin irregularity on her neck. On physical examination, there were multiple pinhead-sized yellowish flat-topped waxy papules on the anterolateral aspects of the neck (figure A). Direct ophthalmoscopy showed prominent angioid streaks (figure B, green arrowheads) with nasal drusen on the right eye (figure B, white arrowheads) and less obvious ones on the left eye. A biopsy sample from the skin of her neck showed a band of degenerated clumps of basophilic elastic fibres in the upper reticular dermis (figure C, green arrows) and Von Kossa stains were positive for calcium deposits within the degenerated elastic fibres (figure D).
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