A 46-year-old white man whose parents were consanguineous presented with diffuse brownish black hyperpigmentation that had appeared 4 years earlier. Physical examination revealed partially coalesced, grayish blue papules on the dorsal and lateral aspects of the first and second fingers of both hands (Figure 1). His ears were mottled, with grayish blue nodules, 1 to 2 mm in diameter, on the right helix and tragus and on the left anti-helix and concha (Figure 2). His eyes showed a brownish black scleral pigmentation, with an ovoid macule at the site of the rectus muscle insertion (Figure 3).
Micali G, Di Stefano AG, Nasca MR, Musumeci ML. A 46-Year-Old Man With a 4-Year History of Diffuse Brownish Black Pigmentation. Arch Dermatol. 1998;134(1):97-102. doi: