Hyperpigmentation and vesicles in a woman with epilepsy

Abstract

From Ta Fund Conf Repr W A 42-year-old woman presented with a 9-month history of increasing hyperpigmentation and recurrent vesicles. The physical examination revealed erosions, healing crusts, scarring, milia, mottled hyperpigmentation, and remnants of vesicles and blisters on the dorsal surfaces of her hands, nose, V-neck area, and face (Fig 1). She also developed facial hypertrichosis that was most pronounced on the zygomatic skin (Fig 2). A direct immunofluorescence study of the skin was performed (Fig 3, A; immunoglobulin G), and her urine was examined with ultraviolet light (Fig 3, B). Her serum iron and ferritin levels were elevated. Lamotrigine had been added for her epilepsy 10 months earlier.