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Quiz Case

Hyperpigmented Patches on Shins, Palms, and Soles

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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).

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Ashish Bhatia, MD, Web Editor, JAMA Dermatology.