Golden-brown dermatosis

Abstract

A 57-year-old female patient presented with an asymptomatic dermatosis of three months' duration on her right lower extremity. Physical examination revealed hyperpigmented macules in the right inguinal region extending towards the thigh. These macules were irregular, with well-defined borders, and a dermatomal distribution, containing a few petechiae. They were negative upon palpation (Photo 1). Varicose veins were also observed on both lower extremities. The patient denied any history of trauma, medication use, or infectious diseases in the months prior to the onset of the condition. Dermatoscopy showed a diffuse brownish-copper pigmented background with red dots and globules, a brown pigment network, and a few gray dots (Photo 2). A skin biopsy was performed using a No. 4 punch biopsy for histopathological study with hematoxylin and eosin (H&E) staining, which showed a preserved epidermis, dermis with papillary edema, marked erythrocyte extravasation, and dense perivascular lymphocytic infiltrates with parietal involvement (Photo 3). General laboratory tests, serologies (HBV, HCV, HIV), coagulation panel, and rheumatological profile were ordered, with results within normal parameters and negative serologies. A consultation was requested with the Phlebology Service to evaluate chronic venous insufficiency, and a Doppler ultrasound was ordered, which showed no abnormalities. Topical treatment with 0.1% tacrolimus once daily was prescribed, with follow-up.