Friday, July 03, 2009

Unusual Pigmentation of Legs

The patient is a healthy 51 yo woman with a 5 - 6 year history of asymptomatic progressive hyperpigmentation of the legs. She is in good general health and takes no medications by mouth. The process started on the calves and has spread proximally to the knees. She has rosacea in addition. She thinks her father has a similar problem.

O/E: Both legs from just above the ankles to the knees show punctate hyperpigmentation. The skin here has a slightly pebbly feel. Other than erythematous papules on both cheeks, the remainder of the cutaneous exam is normal. (There is no sclerodactyly, telangiectasas or sclerotic changes).

Affected skin

Digital Zoom

Normal Skin (adjacent)

Dermoscopic Image

Lab: Biopsies of affected and normal skin were taken.

Diagnosis: Punctate Hyperpigmentation of the Legs. This does not look like the "salt and pepper" picture of scleroderma. Could this be an unusual genodermatosis?

Plan: Present to VGRD. Perhaps get serologies for scleroderma.

References: Nothing helpful found on PubMed.


  1. David, You mention she has had rosacea. Any minomycin taken. It is not the usual dermatoscopic picture though of Minomycin hyperpigmentation. Is it a late onset nevus spilus? Otherwise the site is against the other inherited types of localised speckled or reticulate hyperpigmentation.= eg Dowling Degos
    Perhaps a stain for amyloid could be done.

  2. Is the pigmentation fixed or variable. Check a Perl iron stain as well. Any other drugs?

  3. I,think it look like schamberg disease(pigmented purpuric dermatosis)and the common site that presented in the legs,histopathologicaly should be proved.
    firas altamimi,basra-iraq


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