Resident Dermatologist: Andrew Krispinsky, MD

Attending Dermatologist: Susan Massick, MD

Dermatopathologist: Catherine Chung, MD

HISTORY:

A 55 year old Asian man presented with a 10 year history of worsening discoloration on his lower legs and arms. He denied history of minocycline or plaquenil use. PCP had attempted multiple topical treatments prior to referral, including urea cream, clotrimazole, and clobetasol without significant improvement. He noted mild pruritus but denied pain or systemic symptoms. Of note, he reported his mother had similar pigmentary changes on her lower legs. On physical exam, there were lacy, follicularly distributed, hyperpigmented macules on bilateral lower and upper extremities with mild associated follicular drop out (Figure 1).

At low power magnification, the biopsy appears to show normal skin.

On high power magnification, aggregates of pink material fill and expand the papillary dermis (red arrow). A few melanophages are also present (yellow arrow)

What is the most likely diagnosis?

  1. dermatopathia pigmentosa reticulosa
  2. macular amyloidosis
  3. dyschromatosis symmetrica hereditaria
  4. CARP
macular amyloidosis