University of Mississippi Medical School (Ms. Bailey), University of Mississippi Medical Center (Ms. Breeden), Departments of Dermatology and Pathology, University of Mississippi Medical Center (Dr. Brodell), Jackson, Miss; private practice, Fondren, Miss (Dr. Wise) rbrodell@umc.edu
DEPARTMENT EDITOR Richard P. Usatine, MD University of Texas Health at San Antonio
Dr. Brodell discloses that he is a principal investigator for multicenter clinical trials for Galderma Laboratories, L.P., Novartis, and GlaxoSmithKline. He also serves on an advisory board for IntraDerm Pharmaceuticals. Ms. Bailey, Ms. Breeden, and Dr. Wise reported no potential conflict of interest relevant to this article.
The patient presented with persistent hyperpigmentation that was unaffected by regular face washing. A simple test both diagnosed and treated the condition.
A 59-year-old woman presented to a dermatology clinic with an asymptomatic brown facial hyperpigmentation that had developed several years earlier, and had persisted, despite regular face washing. Physicians who previously treated this patient interpreted this as melasma and advised her to wear sunscreen. The condition was not aggravated by sun exposure. The patient reported that she was otherwise healthy.
Physical examination revealed a brown discoloration with a slightly rough texture. Upon rubbing the affected area with a 70% isopropyl alcohol pad, normal skin was revealed (FIGURE 1A) and brown flakes were apparent on the gauze (FIGURE 1B).
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