Armloads of pigmentation

CASE #1

A 25-year-old Mexican woman presented with ashy brown-blue macules that had developed on her arms and upper torso after puberty. She did not know whether the macules had ever been erythematous or had an erythematous border. Negative rapid plasma reagin testing ruled out late-stage pinta. Biopsy revealed a sparse lymphocytic dermal and perivascular infiltrate as well as scattered dermal melanophages. Wood’s lamp examination suggested the pigmentation was dermal. Sunblock had no effect on the eruption. The patient declined clofazimine when told it could change the color of her skin, and then she refused further follow-up.

CASE #2

The patient was a 30-year-old white woman who, six months before, noted tingling extending from her upper torso down her left arm. Soon the area of the tingling exhibited vesicles on an erythematous base. Diagnosed with herpes zoster, the patient was given acyclovir 400 mg three times a day for a week. The vesicles crusted over and resolved, leaving behind reticulated brown macules. Unhappy about the color, she came seeking care. She was taking no medications—prescription or OTC. In the months before the eruption occurred, she had been under a great deal of personal and professional stress. She thought that she had had a mild case of chickenpox as a child.

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