Presenter: Heather Orkwis, DO
Dermatology Program: St. Joseph Mercy Hospital
Program Director: Daniel Stewart, DO
Submitted on: December 17, 2011
CHIEF COMPLAINT: >10 year history of dark, itchy spots on legs
CLINICAL HISTORY: A 44-year-old woman presented with a greater-than-10-year history of dark, itchy spots on legs. She complained of pruritic, progressively worsening dark spots on the bilateral anterior lower legs. She used a bleaching cream on the areas 8 years prior without improvement. The patient has insulin resistance, hypertension, and arthritis.
PHYSICAL EXAM:
There are hyperpigmented, keratotic plaques on the bilateral anterior lower extremities.
LABORATORY TESTS: N/A
DERMATOHISTOPATHOLOGY:
Punch biopsy showed a hyperkeratotic epidermis overlying papillary dermal deposits of homogenous material.
DIFFERENTIAL DIAGNOSIS:
1. Acquired Ichthyosis
2. Lichen Aureus
3. Lichen Simplex Chronicus
4. Keratosis Pilaris
5. Scleroderma
