Forum for Nordic Dermato-Venereology Nr2,2017 | Page 33

Quiz An Usual Dermite Ocre of the Lower Limbs: A Quiz N icolas K luger , R egional E ditor , F inland Departments of Dermatology, Allergology and Venereology, Skin and Allergy Hospital, University of Helsinki and Helsinki University Central Hospital, PO Box 266, FIN-00029 Helsinki, Finland. E-mail: [email protected] A 65-year-old Caucasian woman presented for the follow-up of a leg ulcer diagnosed as distal calciphylaxia treated by local injection of sodium thiosulfate. Her past medical history was notable for hypertension, non-toxic multi-nodular goitre, systemic lupus and osteoporosis. Her regular medication included currently and notably, antihypertensive treatments (candesartan and lercanidipin), prednisolone, azathioprine, oral calcium and vitamin D supplementation, bisphosphonate (ibandronate) and citalopram. (omitted here on purpose in the present text) in the anamnesis provided the diagnosis of this hyperpigmentation. What would you have asked to the patient? What is your diagnosis? See next page for answer. Upon presentation, leg ulcer had closed. Examination dis- closed a striking asymptomatic dark-brown hyperpigmenta- tion of the lower limbs that involved the whole legs (Fig. 1). The pigmentation has been present for several years according to the various medical records. It was sometimes considered as a “dermite ocre” in a context of venous insufficiency. How- ever, doppler ultrasound imaging of the veins of the lower limbs failed to find any remarkable venous insufficiency. A vascular surgeon had ruled out any arterial or venous lower limbs insufficiency. The rest of skin, nails and mucosa were free of any pigmentation. However, an additional information Fig. 1. Intense brown pigmentation of the lower limbs. Forum for Nord Derm Ven 2017, Vol. 22, No. 2 63