Intensely pruritic papules with reticulated hyperpigmentation

A 31-year-old white woman presented with a 3-year history of a waxing and waning eruption associated with intense pruritus. There was otherwise no pertinent medical or family history. She had previously tried antifungal cream, topical steroids, and minocycline without much improvement. The physical examination revealed reticulated hyperpigmented patches on her chest, back, and hips. Superimposed on these patches were discrete, erythematous, pinpoint, sandpaper-like papules (Fig 1). A biopsy specimen was obtained from a patch on her chest, and the histopathologic examination revealed mild spongiosis, a focal interface dermatitis with necrotic keratinocytes, a superficial dermal and perivascular lymphocytic inflammatory infiltrate with occasional neutrophils (Fig 2), and occasional dermal melanophages (arrows, Fig 3).

http://ift.tt/2jKageH