A man in his 30s presented with reticulate hyperpigmentation, progressive since early childhood, overlying the trunk and extremities (Figure, A and B). Physical examination revealed normal fingernails and toenails, dermatoglyphics, and dentition. Additionally, there was no evidence of alopecia or keratoderma. Review of systems was remarkable for hypohidrosis, photophobia, and a history of recurrent sinopulmonary infections, including pneumonia, requiring hospitalization. Family history was notable for similarly affected men on the patient’s mother’s side. A punch biopsy specimen was obtained (Figure, C and D).