Presenter: Christina Steinmetz-Rodriguez, DO

Dermatology Program: West Palm Hospital/PBCGME

Program Director: Robin Shecter, DO

Submitted on: April 20, 2015

CHIEF COMPLAINT:  A 32-year-old Hispanic male presented to the dermatology clinic with recurring hyperpigmented patches on his face over the past year that was transient.

CLINICAL HISTORY: A 32-year-old Hispanic male presented to the dermatology clinic with recurring hyperpigmented patches on his face over the past year that was transient. Lesions would erupt in the same location on his face each time on a monthly basis and resolve in 6 to 7 days. Denied any prior medical history and reported no medication use including over-the-counter medications.

PHYSICAL EXAM:
Well-defined 2 cm circular hyperpigmented patch over his right zygoma with mild scaling at the periphery.

Two 0.5 cm hyperpigmented macules bilaterally on the lower lip, and a 1 cm macule in the philtral ridge.

LABORATORYTESTS: N/A

DERMATOHISTOPATHOLOGY:

Shave biopsy of the zygomatic lesion revealed interface vacuolar changes with dermal melanophages and some eosinophils, as well as near full-thickness epidermal necrosis.

PAS stain failed to reveal any dermatophytes. However, the PAS did reveal a normal thickness of the epidermal basement membrane consistent with fixed drug eruption.

DIFFERENTIAL DIAGNOSIS:

1.   Tinea
2.   Fixed Drug Eruption
3.   Lichen Planus
4.   Steven Johnson Syndrome
5.   Contact Dermatitis