A clinical, histologic, and ultrastructural study of 32 cases of white fibrous papulosis of the neck was undertaken. Clinically, this condition is characterized by asymptomatic white papules that appear mainly around the neck in elderly persons. The papules are approximately 2 to 3 mm in diameter, round to oval, clearly marginated, and unrelated to the hair follicles. The major pathologic change revealed by light microscopic examination is a relatively circumscribed area of thickened collagen bundles in the papillary to mid dermis. Ultrastructurally, no remarkable morphologic change is seen in either the collagen or the elastic fibers, except for a variation in the diameters of collagen fibrils within the lesion compared with perilesional normal skin. White fibrous papulosis of the neck appears to be a new clinicopathologic entity, cases of which to date have been reported only in Japan.