A 61-year-old black woman presented to the dermatology clinic at The Johns Hopkins Hospital, Baltimore, Md, with a 5-year history of a pruritic eruption that flared during the summer, but was present year around. Previous attempts at management with multiple topical steroid preparations had not been successful. Her general health was good except for mild hypertension, which had been treated in the past with hydrochlorothiazide. She was receiving no medication on presentation.
Results of physical examination revealed hyperpigmentation and lichenification involving her face, posterior aspect of the neck, upper part of the back, upper aspect of the chest, dorsal forearms and hands, and anterior shins (Fig 1).
Skin biopsy revealed epidermal acanthosis and spongiosis with microvesiculation, scattered dyskeratotic keratinocytes, and a superficial dermal perivascular lymphocytic infiltrate (Fig 2).
Phototesting was performed; this revealed minimal erythema doses (MED) of less than 1 J/cm2 for UVA radiation (normal, 80 to 100 J/cm2) and 30 mJ/cm2 for UVB radiation (normal, >100 mJ/cm2). No photosensitivity to visible light was noted. Results of complete blood studies, including antinuclear antibody titer determination, complete blood cell count, and serum electrolyte and chemistry panels, were unremarkable. An ophthalmologic examination was within normal limits.