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November 2007

Brown and Black Scaly Patches on the Lower Leg—Quiz

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Arch Dermatol. 2007;143(11):1441-1446. doi:10.1001/archderm.143.11.1441-a

A 69-year-old man presented to the dermatology clinic with chronic swelling of the lower legs accompanied by pruritus and scaling. He had noticed a gradual increase in pigmentation of the lower part of his left leg. His medical history included congestive heart failure, hypertension, and protein C deficiency with deep venous thrombosis of the lower part of the left leg.

Physical examination revealed bilateral (≥2) pitting edema of the legs extending proximally to his knees, associated with violaceous erythematous scaling patches and superficial erosions of the right lower extremity. On the left anterior tibial surface were brown hyperpigmented patches with fine scale admixed with speckled black pigment (Figure 1). There were no other skin findings. A punch biopsy specimen was obtained from both lower parts of the legs and stained with hematoxylin-eosin, melanin, and iron stains (Figure 2 and Figure 3).

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