Quiz Case

Hyperpigmented Patches on Shins, Palms, and Soles

Image of figure 1
Image of figure 2
Image of figure 3

Figure 1.

Figure 2.

Figure 3.

A 54-year-old woman presented with a 2-year history of a mildly pruritic, golden-brown rash that first developed on her palms and progressed to her shins and soles. The patient’s medical history and medications were unremarkable. Physical examination revealed dusky, reddish-brown patches on her bilateral soles and reddish-brown patches with scattered red puncta on the dorsum of her feet, shins, and palms (Figure 1 and Figure 2). Laboratory test results showed no abnormalities for full blood cell count, double-stranded DNA, antinuclear antibody, serum protein electrophoresis, and erythrocyte sedimentation rate. A shave biopsy specimen was obtained (Figure 3).

See the full article for an explanation and discussion.

For comments or suggestions about the JAMA Dermatology Clinical Challenge, please contact us at jama-comments@jamanetwork.org.
Ashish Bhatia, MD, Web Editor, JAMA Dermatology.