reticulate hyperpigmentary disorders are a group of rare genetic pigmentary abnormalities which includes reticulate acropigmentation of kitamura ( rapk ) , dowling degos disease ( dd ) , reticulate acropigmentation of dohi ( rapd ) , haber 's syndrome , and galli - galli disease.a few reports on the coexistence of rapk and ddd have been reported in the literature.there is one previous report of an overlap of rapk , rapd , and ddd . reticulate hyperpigmentary disorders are a group of rare genetic pigmentary abnormalities which includes reticulate acropigmentation of kitamura ( rapk ) , dowling degos disease ( dd ) , reticulate acropigmentation of dohi ( rapd ) , haber 's syndrome , and galli - galli disease . a few reports on the coexistence of rapk and ddd have been reported in the literature . there is one previous report of an overlap of rapk , rapd , and ddd . reticulate hyperpigmentary disorders are a group of rare genetic pigmentary abnormalities which are inherited in an autosomal dominant fashion . it includes reticulate acropigmentation of kitamura ( rapk ) , dowling dego 's disease ( ddd ) , reticulate acropigmentation of dohi ( rapd ) , haber 's syndrome , and galli - galli disease ( ggd ) . we herein present a case with overlap features of rapk and ddd along with hypopigmented lesions , acneform facial scars , and unusual sites of reticulate hyperpigmentation . a 25-year - old male presented to us with asymptomatic dark - colored lesions on his hands and feet and light - colored skin lesions involving the trunk since three years . the dark - colored lesions increased progressively in number to involve other parts of his body . there was no history of similar complaints in the family and he was not a product of consanguinity . dermatological examination revealed mildly atrophic , hyperpigmented macules in a reticulate pattern involving the dorsa of the hands and feet [ figure 1a and b ] , front and sides of neck , and axillae [ figure 1c and d ] . in addition , he had similar lesions on the periorbital region [ figure 2a ] , groin , and scrotum [ figure 2b ] . he also had multiple hypopigmented macules widely distributed over the trunk and anterior aspect of both legs [ figure 2c ] . he also had multiple nonacne facial scars predominantly on the nose and malar areas [ figure 2d ] . reticulate hyperpigmentation on : ( a ) dorsa of both hands ( b ) dorsa of both feet ( c ) neck ( d ) axilla unusual features : ( a ) reticulate hyperpigmentation in periorbital area ( b ) reticulate hyperpigmentation on scrotum ( c ) hypopigmented macules on trunk ( d ) acneiform scars on nose skin biopsy from a hyperpigmented lesion on the dorsum of the hand revealed filiform elongation of rete ridges with hyperpigmentation of basilar keratinocytes and clusters of melanocytes at the tip of the rete ridges . histopathology axillary lesion was also similar except for features of follicular plugging [ figure 3a and b ] . melan - a stain confirmed increased melanocytes [ figure 3c ] ; skin biopsy from hypopigmented lesion on left leg revealed decreased melanocytes [ figure 3d ] . histopathology of skin lesions : ( a ) biopsy from axillary lesion demonstrating filiform elongation of the rete ridges , hyperpigmentation of basilar keratinocytes , and clusters of melanocytes at the tip of the rete ridges along with follicular plugging ( h and e , 10 ) ( b ) high - power view of the same ( h and e , 40 ) ( c ) melan - a staining demonstrating the increased melanocytes ( 40 ) ( d ) biopsy from hypopigmented macules showing reduced number of melanocytes ( h and e , 40 ) about 100 cases have been reported so far , mostly in the asian ethnic groups . a network of freckle like pigmentation on the dorsa of hands and feet , palmoplantar pits , and break in dermatoglyphics are present . histopathological examination shows epidermal atrophy associated with clublike elongation of rete ridges and clumps of melanocytes in the basal layer . it is characterized by reticular hyperpigmentation of flexor areas mainly the neck , axilla , antecubital fossa , submammary area , and groin . dark comedo - like lesions on the face and neck and pitted perioral acneiform scars maybe present . the differentiation between rad and rapk is based on clinical and histological findings . in rapk , there are usually no hypopigmented macules and histologically there is epidermal atrophy and increase in the number of basal melanocytes . ggd was first described in 1982 in two brothers manifesting with hyperpigmented macules on the face and neck similar to ddd . however , histopathologically they showed acantholysis in the suprabasal epidermal layers and so were easily differentiated on performing a skin biopsy . haber 's syndrome is usually characterized by verrucous papules on the trunk and acneiform facial scars . our patient had acral pigmentation and palmar pits resembling rapk with flexural involvement resembling ddd . there have been many reports on the coexistence of rapk and ddd in the literature . therefore , some authors suggest that rapk and ddd are different ends of the spectrum of the same disease . in 1986 , crovato reported a family in which the clinical features of ddd were associated with those of rapk . there is one previous report of an overlap of rapk , rapd , and ddd . our patient had reticulate hyperpigmentation of the dorsa of hands and feet along with extensive hypopigmented macules distributed over the trunk and limbs . perioral scars have been reported in ddd , but not nasal or malar area scars . so , our patient could be having features of haber 's disease which characteristically has acneiform facial scars . this further brings us to the surmise that all these entities may be a part of the same disease . adapalene , systemic retinoids , and q - switch alexandrite laser have been tried in a few patients with mixed results . we therefore had a patient with overlap features of rapk and ddd which itself is rarely mentioned in the literature . in addition , he also had features of extensive hypopigmented macules and acneiform facial scars . in addition to features of an overlap of rapk and ddd , our patient also had hypopigmented macules and acneiform scars with no preceding acne . this combination of features has rarely been reported in the literature.all the reticulate hyperpigmentary disorders maybe a part of the same disease entity . in addition to features of an overlap of rapk and ddd , our patient also had hypopigmented macules and acneiform scars with no preceding acne .
reticulate hyperpigmentary disorders are a group of rare genetic pigmentary abnormalities which includes reticulate acropigmentation of kitamura ( rapk ) , dowling - degos disease ( dd ) , reticulate acropigmentation of dohi ( rapd ) , haber 's syndrome , and galli - galli disease . a 25-year - old male presented with asymptomatic dark - colored lesions on his hands and feet with light - colored skin lesions involving the trunk since three years . 
 dermatological examination revealed hyperpigmented macules in a reticulate pattern involving the dorsa of the hands and feet , front and sides of the neck , axillae , periorbital region , and groin . 
 multiple pits were present over both palms , with breaks in dermatoglyphics . 
 he also had multiple nonacne facial scars predominantly on the nose and malar areas . 
 the patient had overlapping features of rapk and ddd . 
 in addition , he also had hypopigmented macules and acneiform facial scars . 
 such an overlap of features of reticulate pigmentation has not been previously reported in the literature .