PMC2651115_01
(A) Generalised hyperpigmented maculopapular rash. Palms, soles and face are also involved. (B) Darier sign: stroking the papular lesion linearly with a blunt instrument gives rise to linear wheal in (C).
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PMC2651115_01_1757-1626-2-69-1.jpg
F1
Examination revealed multiple oval/round hyperpigmented papules and plaques distributed all over the body (face, trunk, extremities and acral areas too)(Fig. 1-A). Darier's sign (papular lesion becomes a palpable wheal after being vigorously rubbed) was positive.(Fig. 1-B &1-C) Pruritus was exaggerated after emotional excitement.** Patchy non-scarring scalp alopecia was present.
Plenty of spindle shaped cells with eosinophilic cytoplasm i.e. mast cells infiltrate the dermis and the appendiceal structures (black arrows). The basal cells show more pigmentation (blue arrows) A:H & E, 10x; B: H & E, 40x.
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PMC2651115_01_1757-1626-2-69-2.jpg
F2
The basal cells showed more pigmentation (blue arrows).(Fig. 2) Complete hemogram, skeletal survey, liver function tests, blood coagulation profiles were normal.