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September 1974

Idiopathic Pigmentation of the Upper Back

Arch Dermatol. 1974;110(3):463-464. doi:10.1001/archderm.1974.01630090089029

To the Editor.—  I was interested to read the account of "idiopathic pigmentation of the upper back" that Dr. El Zawahry claims to be a new syndrome (Arch Dermatol 109:101-102, 1974). However, I was surprised to find that the author did not include macular amyloidosis in the differential diagnosis of the pigmentation in his cases. Macular amyloidosis appears to be not uncommon in Middle Eastern countries1-3 and has a predilection for the upper back and interscapular regions.1,2 Figure 1 of El Zawahry's communication appears to show a "rippled" or reticulate quality to the pigmentation. The histopathological description of these cases indicated that pigmentary incontinence was a prominent feature. In macular amyloidosis, the deposits of amyloid in the dermal papillae may be sparse so that more than one biopsy may be necessary to confirm the diagnosis. In most cases of macular amyloidosis, pigmentary incontinence is also a prominent feature

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