History: 35-year-old African-American female who presented to clinic complaining of a history of papules on the chest and back for many years. She has tried multiple topical acne therapies including tretinoin cream, benzoyl peroxide gel, clindamycin gel, adapalene cream, and hydroquinone with only mild improvement.
Physical Exam: 1-2 mm perifollicular, dark brown papules on the chest and back (Fig. 1 and 2)
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