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October 1992

Combined Acral and Flexural Reticulate Pigmentary Anomaly

Author Affiliations

Department of Dermatology University of California at San Francisco 400 Parnassus Ave San Francisco, CA 94143

Arch Dermatol. 1992;128(10):1411-1412. doi:10.1001/archderm.1992.01680200123032

To the Editor.—  We describe a patient with a combination of acral and flexural hyperpigmentary features characteristic of both Kitamura acropigmentatio reticularis (KAR) and Dowling-Degos disease (DDD). The findings demonstrated in this patient support the concept that KAR and DDD are variable expressions of one genetic disorder.

Report of a Case.—  A 36-year-old Hispanic woman had asymptomatic acral pigmentation that had gradually progressed for 30 years. Sharply demarcated 1- to 5-mm depressed pigmented macules in a reticulate pattern were noted on the dorsal and lateral aspects of her hands, wrists, ankles, and feet. She had noted a similar, bilateral, progressive, axillary, macular hyperpigmentation for approximately 10 years (Fig 1). Her palms revealed pits and linear breaks disrupting the epidermal ridge pattern (Fig 2).Skin biopsy specimens from both the depressed pigmented skin and adjacent normal-appearing skin were obtained from the dorsal web spaces of the hand. A biopsy specimen of