A 31-year-old African American woman presented for evaluation of an increasing number of diffuse, asymptomatic, hypopigmented macules of 2 to 3 years' duration. She had no history of inflammatory lesions, but she did have an 18-year history of hyperkeratotic papules, which were predominantly distributed on her forehead (Figure 1) and upper trunk area. The hyperkeratotic papules were associated with pruritus that worsened when the ambient temperature increased. There was no family history of a similar eruption. A histopathologic section from an abdominal hypopigmented macule was stained with MART-1 (melanoma antigen recognized by T cells) (Figure 2 [the clinical hypopigmentation is on the left side]). A section of an abdominal hyperkeratotic papule was sent for routine histopathologic analysis (Figure 3).
Fangman WL, Selim MA, Murray JC. Diffuse Hypopigmented Macules—Quiz Case. Arch Dermatol. 2006;142(2):235-240. doi:10.1001/archderm.142.2.235-a