A 29-year-old woman presents for evaluation of changes in her skin, which she first noticed during her late teens. The changes have been asymptomatic and slowly progressive, and various providers have given different explanations for them at different times. However, she has never been seen by dermatology prior to this visit, which is ostensibly for treatment of hand warts and eyelid dermatitis.

Aside from being somewhat atopic, the patient is in otherwise excellent health. Laboratory work done as part of a recent physical showed her lipid levels to be well within normal limits. A discussion of family history reveals she has a sister with the same type of skin changes; however, she too has never received a definitive diagnosis from any of the many providers who have evaluated her over the years.

The patient points to changes in several intertriginous locations, including bilateral neck skin, both antecubital areas, axillae, and crural folds. The skin in those areas has an odd cobblestone-like papularity, appears atrophic, and is light yellow. The changes are barely palpable. The midline posterior neck is spared, but the same changes can be seen on oral mucosal surfaces. Elsewhere, there are no signs of hypermobile joints or of cutis laxa. No evidence of excessive sun exposure is observed.

Several punch biopsies show distorted, fragmented elastic fibers in the mid to deep reticular dermis. Taken in context with the clinical facts as presented, this probably means the patient has: