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JAMA Dermatology Clinicopathological Challenge
March 11, 2020

Unilateral Atrophic Hyperpigmentation

Author Affiliations
  • 1Department of Dermatology, University Hospital Leipzig, Leipzig, Germany
JAMA Dermatol. 2020;156(5):583-584. doi:10.1001/jamadermatol.2020.0069

A woman in her late 20s presented with an asymptomatic hyperpigmentation on the right side of the trunk, right upper arm, and right leg, strictly following the lines of Blaschko (Figure, A and B). A slight atrophy of the hyperpigmented skin was palpable without any signs of induration.

The first onset was in her childhood, at the age of 6 years, with a small hyperpigmentation on the right side of her lower chest remaining stable for years. In her early 20s the area of hyperpigmentation started to spread slowly over the above-mentioned areas and became more and more intense. Intravenous penicillin G therapy with 10 million units 3 times daily over 1 week combined with a UV-A1 phototherapy in 18 sessions with a maximum dose of 40 J/cm2 and a cumulative overall dose of 670 J/cm2 showed no effects. A punch biopsy was obtained (Figure, C and D).

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