Progressive hyperpigmented patches

Presenter: Zaina Rashid DO
Dermatology Program: Midwestern University/ Arizona Desert Dermatology
Program Director: Don Anderson DO
Submitted on: Dec 28, 2010

CHIEF COMPLAINT:  Brown patch in both armpits for three months

CLINICAL HISTORY:

Signs and symptoms:  A 73 year old man presented with asymptomatic dark brown patches in the axillary area for 3 months duration.

Previous Treatment:  None

Other information:  There was no history of prolonged sunexposure or trauma in that area. Patient denied any symptoms of pain or pruritus. Patient past medical history includes hypertension with atenolol being his only medication.

PHYSICAL EXAM:

On physical exam, there were well demarcated brown mottled patches in both axillae. There was no involvement of the extremities, nail or oral mucosa. (figure 1,2)

Left axilla

 

Right axilla

LABORATORY TESTS:

Autoantibodies and complete blood workup was performed resulting in negative or within normal limits outcome.

DERMATOHISTOPATHOLOGY:

Several biopsies were performed showing (figure 3) focal atrophy in the epidermis, a band like lymphocytic infiltrate associated with pigmented macrophages and interface vacuolar change. A PAS stain was negative for fungal elements, and immunoperoxidase staining for mycosis fungoides was negative as well (figure 4,5).

 

 

DIFFERENTIAL DIAGNOSIS:

1.   Acanthosis nicrgans
2.   Erythema dyschromicum perstans
3.   Mycosis fungoides
4.   Axillary granular parakeratosis
5.   Lichen planus


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