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Sep 2012

Chronic Hyperpigmented Scaly Plaques—Quiz Case

Author Affiliations
 

SECTION EDITOR: MARY S. STONE, MD; ASSISTANT SECTION EDITORS: SOON BAHRAMI, MD; CARRIE ANN R. CUSACK, MD; SENAIT W. DYSON, MD; MOLLY A. HINSHAW, MD; ARNI K. KRISTJANSSON, MD

Arch Dermatol. 2012;148(9):1073-1078. doi:10.1001/archdermatol.2012.1494

A 47-year-old black woman of Haitian descent presented with a 20-year history of a persistent nonpruritic rash involving her trunk and the proximal aspect of her legs. Prior lesions had also involved her buttocks and breasts. She had tried several courses of topical steroids, with no improvement. Her medical history was remark-able for Crohn disease, which was in remission. There was no family history of similar skin lesions.

Physical examination revealed well-demarcated, circular, scaly, hyperpigmented plaques with an atrophic cigarette paper texture on the trunk, thighs, and buttocks (Figure 1 and Figure 2). The findings of laboratory investigations, including a complete blood cell count, liver function tests, thyroid-stimulating hor-mone, albumin, and a basic metabolic panel, were normal. A chest x-ray film showed no abnormalities. The results of a potassium hydroxide preparation and a fungal culture were negative. A skin biopsy specimen was obtained from a plaque on the trunk (Figure 3).

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