A 6-month-old daughter of nonconsanguineous parents was seen with multiple polycyclic dark to less dark brown, partly livid shimmering macules, which covered large areas of the back, neck, buttocks, and lower extremities (Figure, A). According to her mother, new lesions had appeared during the past weeks on the shoulders. Physical examination revealed coarse facial features, hepatomegaly (7 cm below the costal arch), distinctive lumbar kyphosis, and muscular hypotonia compared with her twin brother. Dermoscopy showed faint clouds of nonhomogeneously distributed light brown pigment.
Papathemeli D, Mohnike K, Ambach A. Multiple Polycyclic Brownish to Reddish Macules on the Skin in an Infant. JAMA Dermatol. 2015;151(11):1249-1250. doi:10.1001/jamadermatol.2015.2469