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Macular arteritis (MA) has a striking discordance between the clinical presentation of hyperpigmented macules and the histopathologic findings of a lymphocytic arteritis with intraluminal hyalinized fibrin ring and thrombosis. It has been proposed that MA represents the chronic, indolent, lymphocytic form of the neutrophil-predominant cutaneous polyarteritis nodosa. MA usually affects middle-aged women asymptomatically on the legs. There is also a slightly more severe variant with more infiltrated plaques and livedo racemosa, termed lymphocytic thrombophilic arteritis. MA and lymphocytic thrombophilic arteritis have similar histologic features, both with a largely intact vascular elastic lamina, despite the abundant fibrin and endarteritis obliterans. There is no evidence for progression from MA to lymphocytic thrombophilic arteritis to cutaneous polyarteritis nodosa, and aggressive therapy should be avoided in MA, given the indolent, benign disease course.

Objective: The study assesses the safety and efficacy of a 675-nm laser source on melasma. Background: Melasma is a frequent acquired skin disease defined by the presence of hyperpigmented macules ...

A 15-year-old girl presented with a 3-month history of non-pruritic hyperpigmented macules on her back (figure 1). Her history included severe obesity and hyperinsulinism. The lesions were previously diagnosed as acanthosis nigricans. Figure 1 Well-demarcated, coalescing, hyperpigmented macules on the patient’s back. Physical examination showed well-demarcated, coalescing and finely scaling macules on the back. Examination with a Wood lamp revealed a yellow-green fluorescence. A diagnosis of pityriasis versicolor (PV) was made. Oral treatment with 2 weeks of fluconazole was …

Dowling-Degos Disease (DDD) is a rare and disfiguring autosomal dominant genodermatosis characterized by reticulate hyperpigmented macules or follicular comedone-like papules in the intertriginous areas that typically presents in the third or fourth decade of life. It is a progressive disease that is often treatment-resistant. Although its association with hidradenitis suppurativa has been well described, DDD has also been less commonly reported in conjunction with other dermatologic diseases with unknown etiologic associations. Herein, we present a case of DDD with associated epidermal inclusion cysts and conduct a literature review of dermatologic conditions reported in association with DDD.

Summary Cutaneous amyloidosis can be a part of a systemic disease or can result from a localized process limited to the skin. It usually presents as pruritic hyperpigmented macules, papules or nodules, which are notoriously resistant to treatment. We performed a hospital-based pilot case series to assess the efficacy and safety of sequential salicylic acid (SA) and glycolic acid (GA) chemical peels. Patients underwent sequential chemical peel therapy with SA 20% and GA 35% used alternately each week for a total of 6 weeks. At subsequent follow-up visits, good clinical outcome and long-term maintenance was observed. This study highlights the promising role of chemical peels in this difficult and distressing disorder.

Dowling Degos disease (DDD) is an uncommon, autosomal dominant genodermatosis characterized by acquired, flexural hyperpigmentation. Clinico-histopathological correlation is diagnostic showing multiple hyperpigmented macules clinically and marked, heavily pigmented, slender and elongated rete ridges on histology. This entity needs to be differentiated from other reticulate hyperpigmentary disorders. Due to rarity of this condition, we report a case of generalized Dowling Degos disease in an adolescent female. Keywords: Dowling Degos disease, Genodermatosis, Hyperpigmentation.

Background Melasma is a common acquired symmetrically distributed hyperpigmented macules of sun-exposed skin. Skin microneedling acts as a transdermal delivery system that facilitates the penetration of lightening agents to deeper layers of skin. Objective Clinical and dermoscopic evaluation of the efficacy and safety of topical tranexamic acid versus topical vitamin C after microneedling for melasma treatment. Patients and methods Twenty patients with facial melasma were enrolled in a split-face prospective, randomized uncontrolled study. The right side of the face was treated with topical tranexamic acid after dermapen microneedling, while the left side of the face was treated with topical vitamin C after dermapen microneedling. Sessions were done every 2 weeks for 6 sessions. The Hemi-MASI score and dermoscopic examination before and after treatment were done. Results Hemi-MASI score was reduced after treatment on both sides of the face, besides improvement of the pigmented lesions showed by dermoscopy on both sides and improvement of the vascular component on the tranexamic acid treated side. Conclusion Topical tranexamic acid or vitamin C application after dermapen microneedling was an effective and safe technique in melasma treatment with minimal side effects, and vascular component improvement by tranexamic acid.

espanolIntroduccion: El liquen plano es una enfermedad papuloescamosa que afecta a la piel, mucosas, pelo y unas. Aparece en ambos sexos y es rara en la ninez. En terminos clinicos posee una forma tipica caracterizada por papulas planas, pruriginosas, purpuricas y poligonales, y diversas variantes relacionadas con su morfologia y localizacion. Casos clinicos: El primero corresponde a una paciente femenina de 10 anos de edad, con dermatosis localizada en extremidades y tronco, constituida por papulas y placas caracteristicas. El segundo es el de una nina de cinco anos de edad, con maculas hiperpigmentadas en cara, cuello y pliegues axilares; maculas hiperpigmentadas o violaceas entremezcladas con lesiones en parches en brazos, tronco, gluteos y muslos, ademas de lesiones en grandes parches violaceos coalescentes en antebrazos y piernas. El estudio histopatologico de ambos casos confirmo el diagnostico de liquen plano. Conclusion: El caso 1 es caracteristico del liquen plano tipico; en el caso 2, las maculas hiperpigmentadas y violaceas que coexisten con lesiones en parches representan un liquen plano pigmentoso difuso, el cual es una variante rara del liquen plano, sobre todo en la edad pediatrica. EnglishIntroduction: Lichen planus is a papulosquamous disorder affecting skin, mucous membranes, hair and nails. It affects both sexes and is rare in childhood. It is clinically characterized by a classic form with flat, pruritic, purpuric and polygonal papules and plaques, and several variants depending on its morphology and location. Clinical cases: The first case is a 10-year-old female, with dermatosis located on the limbs and trunk, consisting of papules and characteristic plaques. The second case is a 5-year-old female, with hyperpigmented macules on the face, neck and axillary folds; hyperpigmented or violaceous macules asociated with patchy lesions on arms, trunk, buttocks and thighs, with lesions in large coalescing violet patches on forearms and legs. The histopathological study of both cases confirmed the diagnosis of lichen planus. Conclusion: Case 1 is characteristic of classical lichen planus; In Case 2, because of the presence of hyperpigmented and violet macules coexisting with patchy lesions, we consider it to be a diffuse pigment lichen planus, which is a rare variant of lichen planus, especially in pediatric age.

Peutz Jeghers syndrome an autosomal dominant condition due to mutation in chromosome 19p13.3 can present with intestinal hamartomatous polyps. Typically, they present with hyperpigmented macules in the mucosa. We present a case of a 13-year-old girl who presented in emergency department with recurrent right sided abdominal pain and tenderness, vomiting, and a palpable mass. Patient has a significant positive family history of hyperpigmented macules. Patient was evaluated with contrast enhanced CT scan and was found to have ileo-ileal intussusception and a gastric fundic polyp. Patient underwent emergency laparotomy and was found to have Jejunojejunal intussusception with polyp at lead point. A 13-year-old girl presented in emergency department with complaints of abdominal pain, nausea & vomiting and constipation of one day duration. The patient was having recurrent episodes of abdominal pain over the past 2 month which previously got relieved after vomiting. There was also history of two episodes of blood in stools over the past 2 months. There was no history of loss of weight or appetite and no alteration in bowel habits. On general examination there were multiple well demarcated hyper pigmented macules on the lips tongue and face. Her father and sister also had similar lesions on the face and lips. Rest of the skin, hair nails trunk extremities gums & palate was normal. On examination abdomen was distended with diffuse tenderness but no rebound tenderness. There was a well-defined tender mass in right iliac and lumbar region.

Dowling-Degos Disease is a rare, pigmentary disorder with variable presentations. The most common among them are hyperpigmented macules and reticulate pigmentary anomaly of flexures. Many other phenotypic variations of Dowling-Degos disease have been reported in literature. We present here a case of Dowling-Degos disease with comedo-like lesions and pits without typical flexural hyperpigmented macules.

Lichen planus pigmentosus and lichen planopilaris are two clinically and histologically distinct forms of lichen planus. Lichen planus pigmentosus presents with sudden onset hyperpigmented macules and patches, predominantly in darker skin phototypes. On the other hand, lichen planopilaris is a scarring follicular variant of lichen planus that presents with progressive, permanent patches of alopecia. It is not uncommon for different variants of lichen planus to clinically coexist with each other. However, to our knowledge, there has been no previous reporting of linear lichen planus pigmentosus of the face with histological features of lichen planopilaris. We herein present a hybrid case of these two entities.

A 20-year-old female presented to the clinic because of hyperpigmented macules on the trunk for 1 month, with symmetric distribution and mild pruritus, no lesions on the face, mucosa, limbs and nails. She denied having any erythematous lesions before, her medical history was significant with hepatitis C virus infection for 1 year.

A 27-year-old woman presented with hyperpigmented patches on the forehead and bilateral cheeks. The onset was one year earlier. Initially, she had erythematous macules then turned spontaneously into hyperpigmented patches. She was diagnosed with allergic contact dermatitites, treated with topical corticosteroid but there was no improvement. She has no specific personal medical history as well as no family history of autoimmune disorders. She is an accountant and a carefully history interrogation revealed no exposure to any new substance or new condition recently. She reported no arthralgia, no fever, no hair loss, no tiredness, no photosensitivity. Physical examination found some hyperpigmented macules and some of them had an atrophic center. On examination with a dermoscope, we observed follicular plugging, telangiectasia, and hyperkeratosis. No fluorescence was observed on Wood's lamp examination of this area. There’s no mucosal lesion.

Objective To compare the effect of combination therapies of topical 3% tranexamic acid versus topical 20% azelaic acid each combined with oral tranexamic acid in the treatment of melasma. Study design Interventional comparative study. Place and duration of study Department of Dermatology, Sheikh Zayed Hospital, Rahim Yar Khan, from July 2017 to June 2018. Methodology Cases of melasma diagnosed clinically (based upon history and the clinical findings of symmetrically distributed hyperpigmented macules and patches on the face), aged 12 to 50 years, were selected. The cases were divided into two groups by simple random sampling method. The cases in group A were treated by oral tranexamic acid (250 mg twice daily) with topical 3% tranexamic acid (twice daily). In group B, cases had oral tranexamic acid (250 mg twice daily) with topical 20% azelaic acid (daily) for six months. They were followed every second month upto 6 months and the efficacy was assessed on the basis of scores on MASI scale. Results In 100 patient, there was no significant difference in terms of mean MASI score at 2 and 4 months with p-value of 0.20 and 0.89, respectively. However, mean MASI score was significantly less in group A (6.06 ±5.06 vs. 10.62 ±7.43) in group B (p=0.001). In group A, 14 (28%) had excellent response, whereas in group B, 11 (22%) had excellent results. Conclusion Combination of oral and topical 3% tranexamic acid is significantly better than oral tranexamic acid with 20% azelaic acid for treatment of melasma.

In this case report we describe a patient with a confirmed diagnosis of Peutz-Jegher syndrome. A diagnosis made from a positive tissue sample from the small bowels and characteristic hyperpigmentation on the patient's lips. This particular patient wasn't diagnosed till he got intussusception which required an operation. There's a possibility that the diagnosis could have been made earlier in the patient's life because of the hyperpigmented macules on his lips in addition to frequent abdominal pain.

A 20 year old male presented with multiple asymptomatic hyperpigmented macules since first year of life without any systemic complaints. Based on clinical information diagnosis of Cafe au lait macules (CALM) was made. CALMs are localized epidermal melanocytic flat lesions, named after their typical coffee-and-milk hue. It can be notice in any body part, incidence being 5% among caucasians. CALM lesions are fairly well demarcated, light to dark brown hyperpigmented macules, size varying from 2 mm to 20 cm, usually a clinical diagnosis, solitary lesions can be a simple benign birthmark, but multiple lesions should alarm us to look for systemic associations like neurofibromatosis, Mc-cune Albright syndrome. The most common type of cafe ua lait macule is light brown pigmented macule, has fairly regular and clearly demarcated margins (“coast of California”). There is a second, less frequent type of CALM that has a much more irregular margin (“coast of Maine”). It is a clinical diagnosis. Treatment solely based on patient’s need, simple reassurance is the usual approach followed, if cosmetically disfiguring then different options tried are Q switched ND: YAG laser, Q-switched ruby laser, Q-switched alexandrite laser, erbium-doped YAG, and pulsed-dye laser.

Lichen planus pigmentosus-inversus (LPP-inversus) which is an uncommon variant of lichen planus, is characterized by well bordered hyperpigmented macules and patches involving intertriginous areas. Since it was first defined, very few cases have been reported worldwide. Herein we report eight new patients with characteristic features of LPP-inversus. The hyperpigmented lesions of our patients were mostly located on axilla and the inguinal region. Two patients also had lesions that were clinically consistent with classic lichen planus. Three patients had lesions with unilateral distribution. In all of the cases a skin biopsy was performed to confirm the clinical diagnosis of LPP-inversus. LPP-inversus is a disease with unique clinical and histopathological features that we should bear in mind in the differential diagnosis of hyperpigmented flexural lesions. The etiopathogenesis and the treatment strategy of this rare entity need to be clarified.

The objective is to study the knowledge that albinos have on skin cancers, and their attitudes in terms of primary prevention and the screening practices for skin cancers in Burkina Faso. Methods: This is a cross-sectional and descriptive KAP study conducted from May 18th to July 7th 2015. It involved albinos aged at least 12 years. Their general knowledge, prevention attitudes and screening practices were considered. Results: All the responding albinos had already heard about skin cancers. Their main source of information was health workers (65.6%). They were showing at least two risk factors (99.2%) but only 68.3% affirmed having already undergone screening for skin cancer. Ignorance of the existence of screening was the main obstacle to it (16/26). The prevention means used was sun avoidance, the use of cream and protection clothing respectively in 84%, 41.5% and 51.2%. The skin lesions found were hyperpigmented macules (77.8%) then actinic keratosis (40.7%) and finally cheilitis (35.8%). We detected 4 cases of skin cancers confirmed by biopsy. Conclusion: Risk factors are frequent. Participation to screening is still insignificant. A lot is still to be done to extend the protection means. A good awareness-raising campaign and the accessibility to protection means remain for all, the best defense in the fight against skin cancers in albinos.

Dowling–Degos disease (DDD) is a late-onset genodermatosis characterized by hyperpigmented macules on the flexures along with scattered comedo-like lesions and pitted acneiform scars. Follicular Dowling–Degos is a rare type of DDD, with only two reports so far. It presents with follicular papules and comedo-like lesions predominantly on the face and trunk. Dermoscopy of follicular DDD shows irregular star-shaped/Chinese letter pattern pigmentation along with comedo-like lesions. Herein, we describe diagnostic clues including dermoscopy in three patients of follicular DDD which can help in differentiating it from other disorders presenting with comedo-like lesions .

Introduction. Melasma is an acquired pigmentary disorder characterized by hyperpigmented macules and/or patches affecting sun-exposed skin. Tranexamic acid (TA) can reduce melanin content of epidermis. Thus, we conducted this study to evaluate the efficacy and safety of tranexamic acid local infiltration in combination with topical 4% hydroquinone cream compared to topical 4% hydroquinone cream alone in patients with melasma.Material and Methods. This study was a prospective assessor- and analyst-blind, randomized split-face clinical trial which was performed on patients with bilateral malar epidermal melasma. A total of 55 patients were enrolled, and each side of their face was randomly allocated to either TA+HQ or HQ alone treatment. The MASI score was applied as an objective measurement to compare two treatment groups. The patient's satisfaction of melasma treatment was evaluated using a four-scale grading, as well.Results. The mean of MASI score in week 16 decreased in both groups significantly (p < 0.01). The therapeutic outcomes were significantly better in TA+HQ group than HQ group (p=0.001). Patients satisfaction with treatment was significantly higher in the TA + HQ group. The difference between the two groups regarding side effect occurrence was not statistically significant.Conclusion. Addition of tranexamic acid injections to conventional hydroquinone therapy can increase the efficacy of topical treatment.This trial is registered withIRCT2015110324865N1.

Cutis tricolor is a skin abnormality consisting in a combination of congenital hyper- and hypopigmented skin lesions (in the form of paired macules, patches, or streaks) in close proximity to each other in a background of normal skin. It is currently regarded as a twin-spotting (mosaic) phenomenon. This phenomenon has been reported so far as a purely cutaneous trait, as a part of a complex malformation phenotype (Ruggieri–Happle syndrome), which includes distinct facial features, cataract, skull and vertebral defects, long bones dysplasia, corpus callosum, cerebellar and white matter anomalies, cavum vergae and holoprosencephaly, and other systemic abnormalities. Cutis tricolor has been also reported as a distinct type with multiple, disseminated smaller skin macules (cutis tricolor parvimaculata) or in association with other skin disturbances (e.g., phacomatosis achromico-melano-marmorata) or in the context of other neurocutaneous phenotypes (e.g., ataxia-telangiectasia and phacomatosis pigmentovascularis) or as a sign of complex malformation phenotypes (e.g., microcephaly and dwarfism). More than 20 studies reporting 40 cases are present in the literature with pure cutaneous or syndromic cutis tricolor phenomena and are analyzed in the present study, confirming and expanding the overall phenotype of cutis tricolor. In particular, (1) the skin abnormalities of the cutis tricolor do not evolve over time; (2) there is a typical facial phenotype with long, elongated face, thick and brushy eyebrows, hypertelorism, deep nasal bridge with large bulbous nose, and anteverted nostrils; (3) the skeletal defects are mild-to-moderate and do not progress or cause relevant orthopedic complications; (4) the neurological/behavioral phenotype does not progress and the paroxysmal events (if present) tend to decrease over time; (5) only three patients developed early onset (treatable) cataracts. Different pathologic hypotheses have been postulated, including, early or late postzygotic mutations involving the same gene loci (in the context of the so-called dydymotic theory): such mechanisms can explain the overall skin, bone, lens, and nervous system phenomena of migration of different streaks of clones in the different tissues.

Background: Dohi's Reticulated Acropigmentation is a rare autosomal dominant genodermatosis with high penetrance, characterized by small, irregular, hypo and hyperpigmented macules on the dorsal surface of the distal extremities. Case: The authors report a case of Dohi’s Reticulated Acropigmentation in a 61 years old female patient. The patient complained of spots on hands, feet and posteriorly face involvement since she was 7 years old. Conclusion: Dohi's Reticulated Acropigmentation is a rare clinical condition, which usually appear in childhood and commonly interrupt their onset before adolescence. The diagnosis is based on clinical data, physical examination and histopathological findings. The treatment is unsatisfactory and still no therapy is proposed.

Nevus spilus is a melanocytic neoplasm characterized by a tan macular background punctuated by multiple hyperpigmented macules or papules that represent various types of nevi. These include junctional and compound nevi, Spitz nevi, and rarely blue nevi. We report a unique case of widespread, multiple nevi spili giving rise to agminated Spitz nevi and congenital-pattern compound nevi that underwent genetic analysis to further characterize the mutational profile of this rare entity.

Dyschromatosis universalis hereditaria (DUH) is a rare autosomal dominant inherited dermatosis which usually appears during childhood and is characterized by dyspigmentation, with both hypopigmented and hyperpigmented macules. We report a case of DUH with unexplained childhood-onset renal failure. The association between DUH and renal failure is yet to be proven by further studies.

Congenital melanotic macules of the tongue (CMMT) are a rare and benign condition that is probably underestimated. We report the case of an African infant with multiple congenital hyperpigmented macules of the tongue. To avoid a difficult-to-perform procedure such as a tongue biopsy, focused clinical monitoring was performed every 3 months for 30 months to detect significant changes. A clinical diagnosis of CMMT was made in the absence of concomitant systemic diseases using the clinical findings, the location on the tongue, the negative family history for melanoma, and the absence of drugs and toxic exposure. Clinical follow-up may be sufficient to monitor CMMT rather than performing a tongue biopsy.

We describe a fifty-six-year old, Afro-descendent female patient showing dystrophy of her twenty nails and hyperchromic, asymptomatic macule on her face. Histopathological examination of the macule showed vacuolization of the basal layer, melanophages in the superficial dermis and lymphoplasmocytic inflammatory infiltrate. Nail biopsy revealed orthokeratotic hyperkeratosis and lichenoid inflammatory infiltrate. Lichen planus pigmentosus is an uncommon variety of lichen planus. It is characterized by typical hyperpigmented macules on the face and neck. Nail changes might be present in 10% of lichen planus cases, but no associations with lichen planus pigmentosus have been described. We report a case of lichen planus in twenty nails associated with lichen planus pigmentosus on the patient's face.

Background Epidermodysplasia verruciformis (EV) is a rare genodermatosis that causes disseminated eruptions of hypo- or hyperpigmented macules and wart-like papules that can coalesce and scale. It is uniquely characterized by an increased susceptibility to specific human papillomavirus (HPV) genotypes. Classically, EV is associated with mutations of the EVER1/TMC6 and EVER2/TMC8 genes. The term "acquired" epidermodysplasia verruciformis was coined to describe an EV-like syndrome that can develop in patients with a compromised immune system. Recent discoveries of other genes implicated in EV, including RHOH, MST-1, and CORO1A, have complicated the classification of EV and EV-like syndromes. Methods We review the available data on epidermodysplasia verruciformis in the literature in order to propose a new classification system to encompass current and future developments on EV and EV-like syndromes. Results We propose classifying EV into: (1) classic genetic EV, (2) non-classic genetic EV, and (3) acquired EV. Conclusion The proposed categorization scheme provides a simple and logical way to organize the different cases of EV that have been described in the literature. This system organizes EV by its cause, allowing for a better understanding of the disease and helps differentiate EV from other causes of generalized verrucosis.

Tinea versicolor (TV) is typically an asymptomatic fungal infection of the stratum corneum owing to Malassezia overgrowth. It presents as hypo or hyperpigmented macules with fine scale that coalesce into patches on the trunk, neck, and/or arms. Presented in this report is a 34-year-old man with an interesting case of folliculocentric tinea versicolor manifesting as perifollicular hypopigmented macules on the lower back.

Introduction. Erythema dyschromicum perstans (EDP) or ashy dermatosis is a rare, benign acquired disease characterized by macular hyperpigmentations. The cause of EDP is unclear although some drugs, toxic agents and internal disorders have been associated with this dermatosis. Objective. Presentation of the first case of the association between EDP and Crohn disease treated with infliximab. Case report. We present a case of a 15-year-old boy with Crohn disease who was treated with infliximab. During the treatment asymptomatic, hyperpigmented macules on the trunk were observed. Based on clinical and histopathological features the diagnosis of erythema dyschromicum perstans was established. Conclusions. Erythema dyschromicum perstans may be associated with Crohn disease and infliximab. Erythema dyschromicum perstans (ashy dermatosis) during the treatment with infliximab in a child with crohn disease

Aim: Ashy dermatosis (AD) is a cutaneous pigmentation disorder with unknown etiology characterized by ash-colored hyperpigmented macules. The diagnosis of Ashy dermatosis is primarily based on the clinical and histopathological findings. In this study, we aimed to identify the dermoscopic features of AD, which may facilitate the diagnosis by reducing the need for invasive procedures. Material and Methods: The study included the patients diagnosed with Ashy dermatosis. Demographic, clinical, dermoscopic and histopathological features of the lesions were reviewed and the findings observed were recorded. Results: A total of 60 lesions from 15 patients were included. The most common dermoscopic finding were irregular linear dots and globules, pinkish brown color was the predominant color of the background, and found to be associated with early lesions. Among the vascular structures observed, irregular linear vessels were the most prevalent. There were no significant differences in terms of dermoscopic structures according to age and localization of the lesions. Conclusion: Dermoscopy can serve as a noninvasive helpful tool for the diagnosis of Ashy dermatosis.

Background: Macular arteritis, macular lymphocytic arteritis (MLA) or lymphocytic thrombophilic arteritis all correspond to an identical new clinicopathological entity. Its individualization as a primary cutaneous lymphocytic arteritis is still controversial for certain authors as it could represent a latent form of cutaneous polyarteritis nodosa. Materials and Methods: We report here 3 additional cases of MLA, present a review of the literature and discuss the disease's nosology. Results: MLA is characterized clinically by a benign skin eruption consisting in bilateral asymptomatic erythematous/hyperpigmented macules mainly located on the lower legs and histologically by a medium-sized cutaneous lymphocytic prominent arteritis present in early cutaneous lesions. Conclusion: These findings support that MLA may be considered as a chronic and indolent primary lymphocytic cutaneous arteritis. Nevertheless, in some cases the objective obliteration of cutaneous vessels underlines the need for continuous monitoring in MLA patients.

Reticulate acropigmentation of Kitamura (RAK) is a rare, autosomal dominant disorder first described in Japan characterised by a reticulate pattern of slightly atrophic, angulated, hyperpigmented macules affecting the acral areas of the body. We hereby report a case of RAK in a young Indian male with adermatoglyphia that has not been previously reported in the literature.

Mongolian spots are congenital hyperpigmented macules of varying size and shape and are usually grayish in color. They occur commonly in the sacrococcygeal area, followed by the gluteal and lumbar areas. We report a Chinese infant with a Mongolian spot in the frontal area; the occurrence of a Mongolian spot in this location is considered exceptional. Awareness of such an occurrence is important, and hence that a false accusation of child abuse is not made. Key words: Chinese, Frontal area, Mongolian spot