Posttreatment lesional hyperpigmentation

Abstract

A 63-year-old man presented to the dermatology clinic with a 1-year history of numerous erythematous, asymptomatic, annular plaques on his abdomen, arms, and legs (Fig 5). His social history included a long career as a trapper in the south Louisiana marshland; none of his close contacts had a similar outbreak. He reported no sensory loss; however, on physical examination, he had a stocking pattern of numbness that extended from his feet to his ankles. Laboratory studies, including an antinuclear antibody panel, a rapid plasma reagin test, rheumatoid factor, and erythrocyte sedimentation rate, were within normal limits. Biopsy specimens with special stains are shown below (Fig 6). Three months after initiating treatment with minocycline and rifampin, he presented with patches of blue-black pigmentation limited to lesional areas (Fig 7), in both sun-exposed and covered sites. Biopsy specimens were obtained from the pigmented areas. Fontana-Masson and Perls stains are shown in Fig 8 and 9. 6.What is the most likely diagnosis? a.Arcuate dermal erythema b.Morphea c.Hansen disease d.Lupus vulgaris e.Tinea corporis 7.What is the most likely causative agent of the patient’s subsequent hyperpigmentation? a.Dapsone b.Bactrim c.Rifampin d.Minocycline e.Amiodarone 8.What is the type of hyperpigmentation associated with the causative agent that is deposited at locations of inflammation and scarring? a.Type I b.Type II c.Type III d.Type A e.Type C 9.In what manner does type II hyperpigmentation generally stain? a.Positive Perls stain, negative Fontana-Masson stain b.Positive Prussian blue stain, negative Fontana-Masson stain c.Positive Perls stain, positive Fontana-Masson stain d.Negative Prussian blue stain, negative Fontana-Masson stain e.Negative Perls stain, negative Fontana-Masson stain Fig 6 View Large Image Figure Viewer Download Hi-res image Fig 7 View Large Image Figure Viewer Download Hi-res image Fig 8 View Large Image Figure Viewer Download Hi-res image Fig 9 View Large Image Figure Viewer Download Hi-res image