connective tissue nevi of the skin are hamartomas , consisting predominantly from one of the components of the extracellular matrix namely collagen , elastic fibres or proteoglycans . we hereby describe a case of eruptive collagenoma in a child which started at an early age of three and half years . we report this case due to its relative paucity of literature in paediatric population coupled with appearance of lesions over an atypical site ( face ) . a 4 year old girl presented to the dermatology department with history of noticing multiple , grouped , asymptomatic raised skin lesions predominantly in bilateral axillae , upper back and face for 6 m. the lesions appeared on normal skin , without any preceding inflammation or trauma . there was no history of epilepsy , developmental anomalies , delay in milestones or any pertinent family history . clinical examination revealed multiple , symmetrically distributed , brownish papules and plaques having a leathery surface ranging in size from 0.2  0.2 cm [ figure 1 ] to 2.5  2.5 cm [ figure 2 ] . few skin coloured , firm , non tender nodules , with surface showing irregular thickening , giving a peau d orange appearance were noted in the axillae [ figure 3 ] . well defined brownish plaques having a leathery surface on flexor aspect of left forearm multiple brownish papules and plaques on the face skin coloured nodules with surface showing irregular thickening giving a peau d orange appearance considering a differential diagnosis of connective tissue nevus , histoid hansen 's and neurofibromatosis the patient was investigated . routine investigations were normal , while histopathology revealed a thickened reticular dermis with haphazardly arranged thickened collagen bundles suggestive of collagen naevus on haematoxylin and eosin stain [ figure 4 ] . masson 's trichrome highlighted an increase in the collagen tissue in the dermis [ figure 5 ] , while verhoeff - van gieson showed a marked paucity of elastic fibres [ figure 6 ] . ( h and e , 100 ) photomicrograph showing dense thick collagen bundles in the dermis . ( masson 's trichrome stain , 100 ) photomicrograph demonstrating an increased collagen with marked reduction in elastic fibres . in an attempt to classify collagenomas , uitto et al . characterized them , based on pattern of distribution ( localized or generalized ) and mode of inheritance ( acquired or inherited ) . while inherited autosomal dominant collagenomas include familial cutaneous collagenomas and shagreen 's patches of tuberous sclerosis , those that are acquired are eruptive collagenomas and isolated collagenomas . eruptive collagenoma , first reported by cramer in 1966 , presents with sudden symmetrical appearance of several firm skin - coloured papules and nodules of various sizes , usually less than 1 cm in diameter , on the trunk and upper extremities , in the first two decades of life . the incidence and pathogenesis is unknown with no established family history or associated systemic findings . histopathologically , the lesions are characterized by an excessive accumulation of randomly arranged dense collagen bundles with either diminished , altered or absent elastic tissue . eruptive collagenoma should be differentiated from other collagenomas namely familial cutaneous collagenoma , which is an autosomal dominated disorder , first described by henderson et al . , in 1968 , characterized by clinical features similar to eruptive collagenoma . however , there is a positive family history , third decade presentation and associated systemic involvement . isolated collagenomas are sporadically acquired collagenomas localized to one body region and not associated with any disease . they can present as paving stone naevi , plantar collagenoma , zosteriform lesions and papulolinear lesions . shagreen patch is a collagenoma variant associated with tuberous sclerosis , characterized by single to few asymmetrically distributed skin - coloured plaques of variable size predominantly in the lumbosacral region . papular elastorrhexis and nevus anelasticus are closely related entities which mimic eruptive collagenomas both clinically and histologically . papular elastorrhexis is characterised by multiple , 2 mm to 5 mm , flat , firm papules over the trunk and extremities while nevus anelasticus present as perifollicular papules . both these conditions are associated with a decrease in elastic fibres . due to paucity of reported literature it is uncertain , whether these entities reflect a part of the same disease process or are separate disease states . this patient was diagnosed as eruptive collagenoma based on first decade presentation of multiple lesions , histopathological findings and the absence of family history and systemic findings . though in most cases the onset of presentation has been beyond the first decade , only two cases have been reported with development of lesions within the first decade . the earliest onset of presentation , in a 2 year old nigerian girl and the other by lee et al . , with onset at 5 years . only 2 case reports by mukhi et al an extensive review of indian literature has yielded a paucity of case reports of eruptive collagenoma . although this entity is relatively uncommon , a good clinical acumen and a degree of suspicion help in the clinical diagnosis of such cases , while histopathology confirms the diagnosis . there is a relative paucity of published case reports in pediatric age group . to the best of our knowledge and after extensive review of literature , we could not find any case reports in indian pediatric population . besides this , involvement of atypical sites like