Document Type : Quiz



Case: A 54-year-old woman was visited with a history of asymptomatic gray-brown discoloration of the facial skin at our dermatology clinic. The lesions first appeared on her chin and then became progressively darker and extended to her nose and, to a lesser extent, to the periphery of her face over a period of five years. She mentioned that the lesions worsened with heat and sun exposure. Her past medical history was unremarkable. The patient’s medications included sunscreens, and hydroquinone lightening creams from many years ago. Physical examination revealed a previous depressed scar of cutaneous leishmaniasis on her forehead, brown to black hyperpigmented macules and patches, more in her midface area, especially the nose and chin, with superimposed small pigmented papules scattered on normal and hyperpigmented facial skin (Figures 1,2). She had no discoloration on other body sites such as the neck, hands or trunk and there was no evidence of arthritis or joint pain. The complete blood cell count, urine analysis and creatinin levels were normal.