6586 What can hide a faun tail? Israel P erez-L opez, Servicio de Dermatolog  ıa, Hospital Comarcal de Baza; Paula Aguayo-Carreras, Unidad de Gesti on Cl  ınica de Dermatolog  ıa, Complejo Hospitalario Universitario de Granada; Jos e David Herrera-Garc  ıa, Unidad de Gesti on Cl  ınica de Neurolog  ıa, Complejo Hospitalario Universitario de Granada; Antonio Mart  ınez-L opez, Unidad de Gesti on Cl  ınica de Dermatolog  ıa, Complejo Hospitalario Universitario de Granada; Carlos Cuenca-Barrales, Unidad de Gesti on Cl  ınica de Dermatolog  ıa, Complejo Hospitalario Universitario de Granada; Ahinoa Maria Bueno-Rodriguez, Unidad de Gesti  on Cl  ınica de Dermatolog  ıa, Complejo Hospitalario Universitario de Granada; Ricardo Ruiz-Villaverde, Unidad de Gesti on Cl  ınica de Dermatolog  ıa, Complejo Hospitalario Universitario de Granada Introduction: Faun tail is a well defined area of congenital hypertrichosis, typically of triangular morphology, situated in the central lumbosacral region. Case report: A 4-year-old girl with no past medical or family history of interest. She was seen in the dermatology department for evaluation of a lumbosacral patch of hypertrichosis that had been present since birth. Examination revealed a clearly defined triangular area of hypertrichosis situated in the central lumbosacral area. At the time of consultation there were no signs of spinal cord lesions or alterations of psychomotor development. In view of these findings, lumbosacral magnetic resonance imaging (MRI) was performed to exclude associated spinal dysraphism. This showed an occult meningocele with a defect of closure of the posterior arch, a probable distal dermal sinus tract, and syringomyelic dilatation of the distal vertebral canal. The patient was diagnosed with occult meningocele with associated lumbosacral hypertrichosis. She remains asymptomatic and is being followed up in neurosurgery. Discussion: Faun tail is a well defined area of congenital hypertrichosis, typically of triangular morphology, situated inthe central lumbosacral region. It is often associated withdefects of closure of the vertebral canal during embryonicdevelop- ment and, even in absence of associated spinal cordsymptoms (alterations of sensitivity, strength, or sphincterfunction), Other cutaneous markers of spinal dysraphism are dimples, dermal sinuses, subcutaneous lipomas, port wine stain, acrochordons, hemangiomas, aplasia cutis, telengiectasia, capillary malformation, etc. The separation of the neuroectoderm from the epithelial ectoderm occurs in the third to fifth week of intrauterine life and is initiated along the posterior midline. The cleavage can be incomplete at any phase, so that a defect may appear in the skin, vertebrae, spinal cord, and/or central nervous system. Conclusion: MRI is recommended to rule out or confirm possi-ble associated spinal dysraphism, which will determine theprognosis and management. Commercial support: None identified. 7014 What is the most satisfactory treatment for skin tightening according to age? Dong Hye Suh, MD, PhD, Arumdaun Nara Dermatologic Clinic; Hye Jin Ahn, MD, Department of Dermatology, College of Medicine, Kyung Hee University; Sang Jun Lee, MD, PhD, Arumdaun Nara Dermatologic Clinic; Ki Heon Jeong, MD, PhD, Department of Dermatology, College of Medicine, Kyung Hee University; Kye Yong Song, MD, PhD, Department of Pathology, Chung-Ang University; Min Kyung Shin, MEd, PhD, Department of Dermatology, College of Medicine, Kyung Hee University Introduction: Decreased elasticity and sagging of skin are a prominent complaint in skin aging. Unipolar, bipolar radiofrequency (RF), and high intensed ultrasound (HIFU) are used for skin tightening. There is no reference to compare the treatment satisfaction of each and to suggest the best treatment strategies that can be recommended according to age. Method: Subjects who received 1 to 5 sessions of monopolar and bipolar RF, and HIFU on the face by a single physician and then followed up for 2-3 months were identified. A total of 54 subjects were reviewed retrospectively. Age of subjects ranged from 28 to 80 years. The age group was divided into \40, 40-59, and $60 groups. Objective and subjective scores for skin tightening were collected. Result: Subjective score was 2.44 for HIFU, 2.29 for bipolar RF, and 2.21 for unipolar RF. The objective score was 2.29 for unipolar RF, 2.26 for HIFU, and 2.07 for bipolar RF. In subjective score, for subjects \40 years of age the bipolar RF was most satisfactory, at 2.43, for people aged 40-59 years unipolar RF was most satisfactory, at 2.25, and for subjects $60 years old HIFU was most satisfactory, at 3.00. Conclusion: According to age, bipolar RF was the most satisfactory in the 30s, unipolar RF in the 40s and 50s, and HIFU in the 60s. Commercial support: None identified. 6354 White fibrous papulosus of the neck Murat Borlu, MD, Erciyes University; G€ ozde Emel G€ orek, Erciyes University; Salih Levent C ¸inar, Erciyes University; Demet Kartal, Erciyes University Introduction: Whıte fibrous papulosus of the neck (WFPON) is a newly defined clinical diagnosis by Shimizu in 1985. It consists of smooth, linear, 2-3 mm papules, independent of the hair follicles on the neck and back. White fibrous papulosus of the neck (WFPON) and pseudoxanthoma elastic-like dermal elastosis (PXE-PDE) are thought to be clinical variants of the same disease. For this reason, some authors have described WFPON, PXE-PDE and other noninflammatory middermal elastosis cases as ‘‘fibroelastolytic variants of primary skin aging.’’ These clinical pictures are clinically similar to each other in many ways, but histologically they can be separated by intact elastic fibers and increased amounts of collagen in the midreticulary dermis. Material and methods: A 70-year-old female patient was admitted to our out patient clinic due to mild itchy papules around her neck for ;2 years. In dermatologic examination; there was a slight yellowish, smoothly confined, nonfollicular papules in the skin color around the neck. Results: Skin biopsy was performed. Histopathologic examination showed normal pattern in elastic fibers with Verhoff, coarsening in collagen fibers in reticular dermis. The cardiologic examination was normal and there was no angioid streak or other abnormality in fundoscopic examination. For this reason, the patient was diagnosed with ‘‘white fibrous papules of the neck’’ clinically and histopathologi- cally. The patient was treated with 3 sessions of Intensed pulse dye laser as treatment. We and marked reduction of papules with treatment. Conclusions: WFPON was first reported in 1989 as a series of 32 cases by Shimizu et al. A few years later, two cases were reported by Rongioletti and Rebora, followed by a limited number of case reports by Kandhari et al., Balus et al., Young Chan Soung et al., Wang et al., and Gencoglan et al. We think that our case is rare and we have achieved treatment successfully with the nonablative laser method in contrast to topical isotretinoin treatments or follow-up without treatment options used in previous case presentations. Commercial support: None identified. 7284 White piedra Alexandra Bourgeois, MD, University of Arkansas for Medical Sciences; Elizabeth Williamson, MD, University of Arkansas for Medical Sciences Background: Piedra is a rare superficial mycotic infection of the hair shaft. Interestingly, the word piedra means rock or stone which describes the clinical appearance of the involved hairs. The fungus clusters together forming little rock- like 1e3-mm nodules along the hair shaft that can be seen with the naked eye. The 2 forms of piedra are white piedra and black piedra which are differentiated by clinical and microscopic examination. White piedra is caused by the fungus Trichosporon beigelii and forms white to light brown, soft, loosely attached nodules that begin beneath the hair cuticle and expand through the hair shaft occasionally leading to hair breakage. White piedra is uncommon; however, it can affect patients of any age or ethnicity. Facial, axillary, and pubic hairs are more frequently affected than hairs of the scalp. White piedra is typically found in humid, tropical climates including southeastern United States. Patients are typically asymptomatic, but seek treatment for cosmetic purposes. Diagnosis involves microscopy of the infected hairs with KOH and a fungal stain which shows nondematiaceous hyphae with blastoconidia and arthroconidia. Diagnosis is also possible with culture on Sabouraud agar which produces cream-colored colonies. The best treatment for white piedra involves clipping or shaving the infected hairs; however, washing the affected hairs with an antifungal shampoo is also acceptable treatment. Observation: A middle-aged Caucasian woman presented with multiple white beads on the hairs of her scalp that have been present for four years. She was previously given the diagnosis of lice before visiting a dermatologist. After microscopic examination she was diagnosed with white piedra and is being treated with antifungal shampoo. Comment: This case of white piedra not only showcases a rare disease, but also demonstrates how physicians tailor treatment plans according to certain cultural or religious preferences. The patient has never cut her hair due to religious reasons and was seeking a treatment that coincides with her beliefs. Commercial support: None identified. SEPTEMBER 2018 JAM ACAD DERMATOL AB313