Persistent and progressive hyperpigmented patches

Presenter: Angela Bookout, DO; Lana McKinley, DO; Khonnie Wongkittiroch, DO
Dermatology Program: Largo Medical Center/ NOVA Southeastern University COM
Program Director: Richard Miller, DO
Submitted on: Sep 30, 2010

CHIEF COMPLAINT:  “Darkening of the skin for four years”

CLINICAL HISTORY:

Signs and symptoms:  A 33-year-old Indian male complained of progressive darkening of his skin beginning on his neck, spreading to his face, and eventually involving both arms over the past 4 years.

Previous Treatment:  None.

Other information:  He has no significant past medical history and no known drug allergies. He denied using oral medications or topical preparations during the past five years. He reported only incidental sun exposure. Review of systems was negative for pain, xerosis, pruritus, dermatitis, alopecia, nail changes or other systemic symptoms.

PHYSICAL EXAM:

Well developed Indian male, skin type IV, with grey-brown macules coalescing into patches symmetrically along face, neck, antecubital fossae, axillae, and dorsal hands. (Figure 1 & 2)

Figure 1
Figure 2

LABORATORY TESTS:

CBC with diff: WNL
CMP: WNL
UA: Negative
Thyroid panel: WNL
ANA: WNL
Lipids: Trig 437, HDL 27, otherwise WNL

DERMATOHISTOPATHOLOGY:

A sparse superficial perivascular lymphocytic infiltrate is accompanied by melanophages and subtle basal cell epidermal damage with pigment incontinence. (Figure 3)

Figure 3

DIFFERENTIAL DIAGNOSIS:

1.   Erythema dyschromicum perstans (EDP)
2.   Confluent and reticulated papillomatosis
3.   Idiopathic eruptive macular pigmentation (IEMP)
4.   Ochronosis
5.   Phytophotodermatitis


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