Hyperpigmented plaques and nodules in a young man

Abstract

A man in his 20s presented with progressive pruritic hyperpigmented plaques that he had since age 16 years. Previous treatments included topical and systemic steroids and narrowband UVB. He denied fevers, chills, lymphadenopathy, weight loss, and night sweats. On examination he had large, round hyperpigmented plaques studded with small, darker papules and nodules involving the trunk, legs, and buttocks (Figs 1 and 2). Punch biopsy revealed a dense superficial and deep lymphocytic infiltrate with prominent perieccrine distribution (Figs 3 and 4).