SOONBAHRAMIMDCARRIE ANN R.CUSACKMDSENAIT W.DYSONMDMOLLY A.HINSHAWMDVINCENTLIUMD
On low power, the punch biopsy specimen showed no apparent findings. On ×100 power, using oil immersion, numerous fine black granules were seen within the sebaceous gland basement membrane, capillary walls, and arrector pili muscle (Figure 2). The granules were also noted prominently in elastic fibers but not in the collagen bundles (Figure 3). The patient began taking selenium supplementation (200 μg/d) for 2 months. After noticing no improvement, he decided to discontinue all therapies and interventions. After 6 months, his skin was largely unchanged.
Generalized Blue-Gray Pigmentation—Diagnosis. Arch Dermatol. 2009;145(9):1053-1058. doi:10.1001/archdermatol.2009.182-b