A 50-year-old African American man with a lifelong history of dark-brown scales covering most of his body presented for evaluation. He reported that his skin condition improved during the summer, during periods when he lived in warmer climates, and with the use of moisturizers. He had a history of asymptomatic corneal opacities that had been discovered on slitlamp examination in 1977. He denied a history of cryptorchidism, testicular cancer, keratosis pilaris, or atopy. His family history revealed the presence of similar skin changes in his 3 brothers and mild changes in his grandson but no changes in any of his sisters. Physical examination showed diffuse involvement, with localized "dirty-brown"–appearing, platelike scales on the anterior aspect of the shins and a finer, fish scale–like pattern involving the extensor surfaces of the upper part of the arms, lower trunk area, buttocks, and upper part of the legs (Figure 1 and Figure 2). There was relative sparing of the elbow and knee flexures, with complete sparing of the face, neck, axillae, hands, and feet. A skin biopsy specimen was obtained from the anterior aspect of the right shin. (Figure 3). Serum lipoprotein electrophoresis showed increased mobility of the low-density lipoprotein cholesterol component compared with a control sample.
Ellison P, Norwood CW, Turiansky GW. Chronic Dark-Brown Scales. Arch Dermatol. 2001;137(11):1521–1526. doi: