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JAMA Dermatology Clinicopathological Challenge |

A 50-Year-Old Woman With Reticulate Hyperpigmentation QUIZ

Mona Ascha, BS1; Mahwish Irfan, MD1; Melissa Piliang, MD1
[+] Author Affiliations
1Department of Dermatology, Cleveland Clinic Foundation, Cleveland, Ohio
JAMA Dermatol. 2016;152(4):461-462. doi:10.1001/jamadermatol.2015.5095.
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A 50-year-old woman presented with a slowly progressive red to brown pruritic hyperkeratotic papules and reticulated hyperpigmentation involving her face, neck, chest, back, and upper and lower extremities; she had been previously diagnosed with Darier disease. What is your diagnosis?

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Photographs of clinical findings of reticulate hyperpigmentation of the (A) neck and chest and (B) lower extremities. Hematoxylin-eosin of (C) hyperorthokeratosis, epidermal acanthosis and elongated epidermal rete ridges with bud-like filiform projections and suprapapillary plate thinning (original magnification ×4) and (D) focal acantholysis without dyskeratosis (original magnification ×10).

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