REPORT OF A CASE
A 59-year-old woman presented with a 20-year history of extensive hyperpigmentation of the upper trunk, neck, and extremities. The pigmentary changes began on the arms and legs, and then spread to involve other areas. Initially, the cutaneous changes were asymptomatic; pruritus developed in a generalized distribution several months prior to her presentation. She had a history of atopic dermatitis during childhood but no history of asthma or allergic rhinitis.On physical examination, the patient appeared to be in good general health. Extensive bilaterally symmetric reticulated macular hyperpigmentation was present on the extremities, the posterior and lateral aspects of the neck, and the upper chest and back, sparing the interscapular areas (Figs 1 and 2). Involvement was most prominent over the extensor surfaces of the arms and legs, where a few small papules were scattered over the pigmented areas. Diffuse xerosis of the extremities was present.
Koch SE. Acquired Macular Pigmentation. Arch Dermatol. 1986;122(4):463-464. doi:10.1001/archderm.1986.01660160119031