Generalized progressive dyschromic guttate rash

A 33-year-old Pakistani man presented with multiple reddish, hypopigmented macules on his chest and back (Fig 1). The lesions appeared 20 years earlier and had progressively increased in number. Flat-topped papules were present over his hands and shins (Fig 2). There was no growth on fungal culture from skin scrapings and no response to topical terbinafine treatment. His parents were cousins, but there was no family history of similar conditions. Blood tests, including a complete blood cell count, HIV, and lymphocyte subsets were normal.

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