PMC4763577_01
(a) Hyperpigmented macules over flexor aspect of forearms. (b) Hyperpigmented macules over dorsum of feet. (c) Hyperpigmented macules over back and dark dot follicles
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F1
The mucocutaneous examination revealed numerous symmetrical brownish hyperpigmented macules, 1-2 mm in size in axillae, groin, flexor and extensor aspects of both forearms, dorsae of hands and feet, both shins and inner aspects of thighs [Figure 1a and b]. Few darkly pigmented comedo-like papules and few atrophic scars were noticeable over upper back and neck [Figure 1c].
(a) Elongated and confluent rete ridges with antler-like branching and dilated follicular infundibula x10. (b) Elongated rete ridges with mild perivascular lymphocytic infiltrates x40
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F2
The tips of rete pegs were hypermelanotic owing to concentrated pigment, which was also scattered within the papillary dermal macrophages [Figure 2a]. Biopsy taken from dorsal aspect of forearm revealed histopathology almost similar to that of biopsy taken from nape of neck except mild perivascular lymphocytic infiltrates [Figure 2b].