PMC5495503_01
Histology of skin demonstrating (a) focal areas of epidermal atrophy and flattening with the loss of the ridges (x10 magnification), (b) mild focal hyperkeratosis (x20 magnification), and (c) basal pigmentation consistent with pigmented skin. Thickened papillary dermis, dermal melanophages with pigmentary incontinence (x40 magnification).
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Nucleotide excision repair studies and histology ruled out xeroderma pigmentosum; skin biopsy showed an epidermis with focal areas of slight atrophy and flattening, focal very mild hyperkeratosis, basal pigmentation consistent with pigmented skin, a slightly thickened papillary dermis, and dermal melanophages together with pigmentary incontinence (Figure 1a-c).
Poikilodermatous changes affecting (a) the upper limb and (b) lower limbs including the soles of the feet.
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In the following months, the pigmentary changes became more widespread involving the limbs and included the palms and soles and the trunk to a lesser extent (Figure 2a and b).