Dermatology: Practical and Conceptual Research Letter | Dermatol Pract Concept. 2023;13(3):e2023161 1 Multiple Familiar Eruptive Dermatofibromas: Report of Three Affected Generations José Alberto García-Lozano1, Gabriel Salerni2, Jesús Alberto Cardenas-de la Garza3 1 Universidad Autónoma de Nuevo León, Departamento de Introducción a la Clínica, Facultad de Medicina y Hospital Universitario “Dr. José E. González’’, Monterrey, Nuevo León, Mexico 2 Dermatology Department, Hospital Provincial del Centenario de Rosario, Universidad Nacional de Rosario, Argentina 3 Universidad Autónoma de Nuevo León, Servicio de Reumatología, Facultad de Medicina y Hospital Universitario “Dr. José E. González’’, Monterrey, Nuevo León, México Key words: dermatofibromas, hystiocitomas, benign fiborus hystiocitomas, benign connective tissue neoplasms Citation: García-Lozano JA, Salerni G, Cardenas-de la Garza JA. Multiple familiar eruptive dermatofibromas: Report of three affected generations. Dermatol Pract Concept. 2023;13(3):e2023161. DOI: https://doi.org/10.5826/dpc.1303a161 Accepted: December 23, 2022; Published: July 2023 Copyright: ©2023 García-Lozano et al. This is an open-access article distributed under the terms of the Creative Commons Attribution- NonCommercial License (BY-NC-4.0), https://creativecommons.org/licenses/by-nc/4.0/, which permits unrestricted noncommercial use, distribution, and reproduction in any medium, provided the original authors and source are credited. Funding: None. Competing Interests: None. Authorship: All authors have contributed significantly to this publication. Corresponding Author: José Alberto García-Lozano, MD, Universidad Autónoma de Nuevo León, Departamento de Introducción a la Clínica, Facultad de Medicina y Hospital Universitario “Dr. José E. González’’, Monterrey, NL, México. Tel: 81 8329 4154 E-mail: dr.josealbertogarcia@gmail.com Introduction Multiple eruptive dermatofibromas (MEDF) is a very rare entity characterized by the development of 15 or more as- ymptomatic lesions all over the body or clustered in one an- atomic location within a short period (usually 4 months) [1]. The pathogenesis is unknown, although most patients with MEDF have underlying causes. Physicians should consider a prompt investigation of underlying conditions, including HIV infection, autoimmune disease, immunosuppressant drug use, and hematologic disease [2]. We report three mem- bers of the same family who developed MEDF. Case Presentation A 50-year-old woman was referred for consultation due to mel- anoma. Clinical examination revealed multiple asymptomatic nodules on the trunk and lower limbs, noting the first nodule during adolescence. More lesions appeared during the next de- cades, and some increased in size. Clinical examination revealed multiple atrophic purple and firm flesh-colored papules, mea- suring between 0.5 and 1 cm in diameter and sinking into the skin with lateral pressure. Dermoscopic examination revealed lesions consistent with dermatofibromas. The rest of the clini- cal examination was unremarkable. During the interview, the patient mentioned that her 87-year-old father and his 34-year- old son also presented similar multiple lesions. Both patients were invited for clinical examination. The otherwise-healthy father had at least 70 lesions on the trunk and lower limbs. The otherwise healthy son had at least 50 lesions in the same areas (Figure 1). Upon questioning, the three family members denied infections, autoimmune disease, malignancies, or immunosup- pressive drug use. A “familiar” MEDF diagnosis was made, and annual follow-up appointments were scheduled. 2 Research Letter | Dermatol Pract Concept. 2023;13(3):e2023161 Conclusions The pathogenesis of dermatofibromas remains unknown. Lesions often develop after a traumatic insult to the skin (insect bites), but altered immunity may play an import- ant role in MEDF [3]. The term “multiple familiar eruptive dermatofibromas” was described by Marque et al in 2013 [4]. This report was the first on healthy individuals of the same family. A genetic cause for MEDF has been suggested with an autosomal dominant inheritance pattern [3]. To our knowledge, this is the first report in which three genera- tions have MEDF with no associated cause. Dermatologists should be aware that MEDF may be a sign of altered immu- nity. Nonetheless, it should also be considered an inherited disorder, especially when multiple family members have the same condition. Figure 1. Polarized clinical images showing multiple lesions consistent with dermatofibromas predominantly located in lower limbs in the 50-year-old woman (upper row), her father (middle row) and her son (lower row). Research Letter | Dermatol Pract Concept. 2023;13(3):e2023161 3 References 1. Zaouak A, Chamil A, Khanchel F, Hammami H, Fenniche S.. Multiple eruptive dermatofibromas. Presse Med. 2019;48 (11 Pt 1):1353-1354. DOI: 10.1016/j.lpm.2019.09.002. PMID:  31727483. 2. Yazici AC, Baz K, Ikizoglu G, Koca A, Kokturk A, Apa DD.. Familial eruptive dermatofibromas in atopic dermatitis. J Eur Acad Dermatol Venereol. 2006;20(1):90-92. DOI: 10.1111 /j.1468-3083.2005.01357.x. PMID: 16405617. 3. Panou E, Watchorn R, Bakkour W, Ratynska M, Bunker CB. Multiple eruptive dermatofibromas in HIV: an immune reconstitution associated disease? J Eur Acad Dermatol Venereol. 2020;34(2):e100-e101.  DOI: 10.1111/jdv.16015 . PMID: 31625625. 4. Marque M, Pallure V, Huet P, Bessis D, Guillot B. [Multiple fa- milial “eruptive” dermatofibromas]. Ann Dermatol Venereol. 2013;140(6-7):452-454. DOI: 10.1016/j.annder.2013.02.018 . PMID: 23773744.