Blue-black hyperpigmented patches on the cheeks

Abstract

A 59-year-old, Black female presented with progressive darkening of her cheeks over several months. For several years, she had been self-treating discoloration on her bilateral cheeks with an over-the-counter skin brightening cream with topical 2% hydroquinone as an active ingredient. She then obtained a prescription for hydroquinone 8% cream and saw no lightening of the areas after 2 months of use. A skin examination revealed dark, blue-black, ill-defined patches with overlying scale bilaterally distributed on the upper medial cheeks (Fig 1).