REPORT OF A CASE
A 26-year-old woman had noted gradually progressive brown spots on her breasts and upper back over the previous five years. Although her main concern was the cosmetic appearance, she had noted occasional mild pruritus in the affected areas. Other physicians had told her the brown areas were due to eczematous dermatitis, but therapy with various topical steroid preparations had no effect. She was otherwise healthy, was taking no medications, and had no family history of any similar skin disorder.Physical examination revealed multiple 1- to 4-mm individual and confluent brown macules in a reticulate pattern on the breasts, around the lower neck, and on the mid upper aspect of the back (Figs 1 and 2). The affected areas on her breasts and neck were smooth, but the area on her upper back was slightly hyperkeratotic. Results of the rest of her skin examination were unremarkable. A skin punch biopsy