Progressive hyperpigmented rash in a middle-aged man

A 44-year-old Indian man presented with a 1-year history of a progressive, nonremitting, asymptomatic rash. The physical examination revealed multiple oval-shaped, hyperpigmented macules and patches scattered on his trunk, thighs, and neck (Figs 1 and 2). In addition, papular lesions were seen on his left wrist. He had no oral or nail involvement. His medications included febuxostat and simvastatin, and a trial discontinuation of these medications failed to resolve the rash. A punch biopsy specimen was obtained (Fig 3), and the laboratory work-up, including autoimmune work-up, was negative.

http://ift.tt/2pccBBY