A 72-year-old woman presented with black macules on her right palm. The macules had appeared suddenly a few weeks earlier, following excessive manual activity in the kitchen. Her history was significant for uncontrollable arterial hypertension, the treatment of which had been modified 1 week before the onset of the eruption. Her current therapy included nifedipine, verapamil, and aspirin.
On physical examination, multiple, well-circumscribed, bluish-black macules were observed on the medial volar aspect of the fifth digit of the patient's right (dominant) hand. The lesions measured 2 to 3 mm in diameter (Figure 1). A 3-mm punch biopsy specimen was obtained (Figure 2).
Rashkovsky I, Safadi R, Zlotogorski A. Black Palmar Macules. Arch Dermatol. 1998;134(8):1019-1024. doi: