Papules on girl with Down syndrome

A 14-year-old girl came into the clinic with an eruption of skin-colored to red-brown papules on her neck and chest that had been present for months. The lesions were usually asymptomatic, but the girl did complain of occasional pruritus. She denied tenderness to palpation. A review of systems was negative for fever or chills.

The patient's medical history was significant for ...