Darkish discoloration of skin involving the back, neck, and upper arms

Presenter: Christopher Buckley, DO; Marcus Goodman, DO; Allison Schwedelson, DO; Angela Combs, DO; Matthew Elias, DO; Emily Rubenstein, DO; Carlos Gomez-Meade, DO; Julian Moore, DO; Rupa Reddy, DO
Dermatology Program: NSUCOM/Broward General Medical Center
Program Director: Stanley Skopit, DO
Submitted on: Dec 23, 2009

CHIEF COMPLAINT:  58 year old Hispanic male with complaints of darkish discoloration of skin involving the back, neck, and upper arms. The discoloration was ongoing for several years.

CLINICAL HISTORY:

Signs and symptoms:  No associated pruritus, pain or previous skin lesions. No new medications.

Previous Treatment:  None

Other information:  Hypertension, not on medication

PHYSICAL EXAM:

Hyperpigmented blue-gray macular eruption coalescing into patches on the anterior shoulders, neck, upper extremities, back and mid-chest. No overlying scale or erythema.

 

Clinical #1

 

 

Clinical #2

 

 

Clinical #3

LABORATORY TESTS:

CBC, CMP, thyroid were within normal limits.

DERMATOHISTOPATHOLOGY:

mild basal cell layer vacuolar degeneration overlying an upper dermis with a mild perivascular mononuclear cell infiltrate and increased melanophages

 

Histology #1

 

 

Histology #2

 

 

Histology #3

DIFFERENTIAL DIAGNOSIS:

1.   Exogenous ochronosis
2.   Lichen planus pigmentosa
3.   Erythema dyschromicum perstans
4.   Drug-induced hyperpigmentation
5.   Contact dermatitis


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