An African American woman in her 60s was admitted to the intensive care unit (ICU) for altered mental status, respiratory failure, and skin sloughing. Her medical history was notable for a recent myocardial infarction but otherwise negative for human immunodeficiency virus (HIV), substance abuse, gastrointestinal tract surgery, or any other chronic disease. Over the months preceding admission, she had become progressively withdrawn from her family, increased her daily alcohol consumption, and noted an unintentional 13.6-kg weight loss, progressive extremity swelling, and decreased nutritional intake. Her dermatologic examination was significant for generalized shiny, enamel-like, hyperpigmented scale in an irregular pattern; when removed, it demonstrated underlying hypopigmentation (Figure, A and B). The physical examination was notable for marked pitting edema and ascites; the mucous membranes, hair, and nails were normal.
Cox JA, Beachkofsky T, Dominguez A. Flaky Paint Dermatosis. JAMA Dermatol. 2014;150(1):85-86. doi:10.1001/jamadermatol.2013.5520