Photo Derm Diagnosis: White papules and atrophic plaques on trunk and extremities

A 42-year-old woman presented with multiple itchy white papules and atrophic plaques over trunk and extremities for last 3 years (figure 1). the lesion first appeared on left flank as white tiny papules. they healed in time to form atrophic plaques; however, new lesions kept appearing and followed the same course. rest of the history was non-contributory. on examination, multiple pearly white papules were found on trunk and extremities. these papules were discrete and were uniform in size, around 3-4mm. apart from these papules, white atrophic plaques were noted. these were both discrete and confluent. face, scalp, mucosa (including genitalia), palm, sole and nails were unaffected. rest of the mucocutaneous examination was unremarkable.