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Blue-Gray Centrofacial Hyperpigmentation

June 30, 2008

A 68-year-old man presented to a university dermatology department with an asymptomatic blue-gray discoloration of the centrofacial region. Physical examination revealed a blue-gray hyperpigmentation of the forehead, cheeks, nose, malar regions and chin (see the accompanying figure). The medical history revealed that the patient was diagnosed with ischemic dilated cardiomyopathy two years previously and was resuscitated from a syncopal episode associated with sustained ventricular tachycardia that was refractory to quinidine, disopyramide phosphate and procainamide. Results of routine laboratory tests were normal. A 3-mm punch biopsy specimen showed normal epidermis and a perivascular deposition of yellow-brown pigment within microphages in the dermis.

Which one of the following is the correct diagnosis, given the patient’s history, the physical and skin biopsy findings?

A. Actinic lichen planus.

B. Hemochromatosis.

C. Amiodarone-induced hyperpigmentation.

D. Ashy dermatosis (erythema dyschromicum perstans).

For the answer visit ffap.

Actually I have seen a patient with this hyperpigmentation and it is very distinguishing feature of the disease. If you see it once, you can’t forget it.

4 Comments leave one →
  1. Ali Imani permalink
    November 2, 2008 9:47 pm


  2. Ali Imani permalink
    November 2, 2008 9:48 pm


  3. November 18, 2008 12:50 pm

    It looks like actinic lichen planus. but I have met with a case phenothiazine -induced hyperpigmentation ,the same like this case

  4. November 18, 2008 1:29 pm

    @fatma: Yes, you right. I read about phenothiazines, but I couldn’t find a good picture to compare with the one above. Can you provide a picture or good link? Thanks!

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