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• Long-term treatment with high doses of corticosteroids leads to the development of truncal obesity and focal fatty deposition. These deposits characteristically are located on the face, the nuchal and truncal areas, and episternally, as well as in the mediastinum and epicardium. We studied a patient with juxta-articular adiposis dolorosa who had L-tryptophan-associated eosinophilia-myalgia syndrome and was treated with high doses of prednisone. This is the first reported case of adiposis dolorosa occurring as a complication of corticosteroid treatment. Alterations of fat metabolism induced by corticosteroid excess may have played a role in the development of this unusual painful syndrome. (Arch Dermatol.1991;127:231-233)

To the Editor.— Drs Butterworth and Johnson ( Arch Dermatol 110:891-893, 1974) called attention to a quite common, cutaneous, anatomical variant, ie, the appearance of tiny (1 to 2 mm) papules, many of which are pierced with a vellus hair, that are grouped in a linear arrangement parallel to the clavical. This condition they term aptly "juxta-clavicular beaded lines" and state that it must be distinguished from papular mucinosis, disseminate and recurrent infundibulo-folliculitis, and cutis punctata linearis colli. However, after reading Even-Paz and Saghers' 1 description of cutis punctata linearis colli, I conclude that both sets of authors are describing the same condition, both clinically and histologically. Drs Butterworth and Johnson state that cutis punctata linearis colli is distinguished from their entity, juxta-clavicular beaded lines, by the fact that the former shows redness of intervening skin between the papules, is caused by prolonged exposure to the sun, and shows a notable

The term juxta-clavicular beaded lines is applied to a common condition characterized by lines adjacent to the clavicles and that are composed of tiny papules arranged in closely placed parallel rows resembling strands of beads. The beaded lines follow the lines of cleavage, are skin-colored, and are formed by globoid papules varying from 0.5 to 1.5 mm in size. Many of the papules are pierced by fine hair. The greatest incidence is in the 11- to 40-year age group, and the condition occurs more commonly in blacks. Results of our histologic studies indicate that the clinical features are caused by a linear arrangement of moderately hypertrophic sebaceous glands and sometimes dilatation of follicular canals associated with vellus follicles at these sites. The lesions are asymptomatic and probably represent an anatomical variant rather than a disease process.

At this time, we are not certain whether "juxta-clavicular beaded lines" and "cutis punctata linearis colli" are the same condition. Certainly, there appear to be many clinical and histologic similarities. On the other hand, there are also some differences. In our cases, the beaded lines were distributed above, overlying, and below the clavicles. They extended from the acromium process to the manubrium. In the latter region, the linear configuration terminated, and the papules ceased or became uniformly dispersed. In the patients of Even-Paz and Sagher, the lines of papules were present on the V area of the neck. This distribution is difficult to understand. We could not find an anatomical description of the V area of the neck either in two dictionaries or in two textbooks of anatomy. Two of our surgical colleagues were embarrassed when we asked them to relate the term to anatomical structures. Thus, we cannot compare

Recently the subject of juxta-articular nodes as a manifestation of syphilis has aroused considerable interest in North America. However, of almost 200 cases reported from nontropical regions, only about 30 have been observed on this continent. According to Hudson, 1 between 1 and 2 per cent of the population between the ages of 30 and 50 in the tropics is affected. The scarcity of reported cases in nontropical regions is, we believe, due in part to incorrect clinical diagnosis, and pertinent reasons will be mentioned later. The purpose of this paper is to report a typical case and to review briefly the historical aspects of and the American literature on this subject. Juxta-articular nodes may be defined as painless, slowly growing subcutaneous fibrous nodules, often symmetric in their distribution and if untreated of long duration. They are situated in the vicinity of a joint, especially of the extremities, and are

The interest shown recently in the subject of juxta-articular nodules is certain to be further stimulated by the brief but excellent historical review of the literature by Drs. Kalz and Newton in the issue of theArchivesofDermatologyandSyphilologyfor December 1943. The statement that small though palpable nodules may occur frequently and most likely escape the attention of the examiner in a routine case of syphilis has left me wondering how many such cases I may have passed over. It is, however, for the small lesions that differential diagnosis becomes most difficult. The number of cases of syphilitic juxta-articular nodules seen was small, no doubt because of the short interval between onset of infection and the clinical examination, as these lesions always begin as tiny nodules and progress slowly over a period of years. From a diameter of a few millimeters they may attain to the