She had a past history of hypercoagulation and mitral valve prolapse with Protein S deficiency and is on warfarin.
Examination of the skin showed diffuse hyperpigmentation on the face extending to the frontal hairline, preauricular hairline and mentum. The areas under the eyes and nose were spared.
Blood counts and biochemistry were normal ANA serology mildly positive. Titre 1:80 (RR<80)
Differentials: photodermatitis > LE > melasma > irritant dermatitis
Q Is the serology titre of 1:80 significant? Could this be LE or melasma? Would you biopsy her skin? If you biopsy, where would you biopsy her? Thanks for your comments.