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To the Editor.—
The condition of hyperpigmentation of the upper part of the back recently described by El Zawahry (Arch Dermatol 109:101, 1974) is not peculiar to Egypt. I suspect it will be found in most civilized countries. I have noted lesions similar in all respects to those he studied while routinely examining patients and while in the course of investigating macular amyloidosis; these asymptomatic pigmented areas are also seen only in postpubertal women. Generally, the areas of hyperpigmentation are located between the tip of the scapula and the dorsum of the shoulder. A third patch is sometimes present to the right or left of the spine and below the level of the scapular tip. The condition tends to be more prominent and to occur more often in obese patients. No relation to complexion type is evident.The patients who were aware of the presence of the abnormality volunteered that
Gerwels JW. Hyperpigmentation of the Upper Part of the Back. Arch Dermatol. 1974;109(5):735. doi:10.1001/archderm.1974.01630050069020
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