Asymptomatic Hyperpigmented Rash in a Healthy Adolescent Female.

1. Renuka Rees, MD* 2. Shannan McCann, MD† 1. *Department of Pediatrics, Brooke Army Medical Center, Joint Base Fort Sam Houston, TX 2. †Department of Dermatology, Wilford Hall Ambulatory Surgical Center, Lackland Air Force Base, TX A 12-year-old healthy girl presents to the pediatric clinic with a chief complaint of a rash that she first noticed 3 months ago. Over the preceding month, the rash spread and became more noticeable. The rash first appeared on her neck and now also involves her abdomen and the extensor surfaces of her upper and lower extremities. The rash is not pruritic or painful. She denies a past history of a similar rash. She recently aggressively scratched an area of the rash after she had been swimming after which she noted resolution of the hyperpigmentation with normal skin underneath. The patient’s mother has tried hydrocortisone 1% cream without improvement. She denies any recent travel outside of the local area. She has not used any new detergents, soaps, or lotions. She denies any changes in nail brittleness, unintentional weight gain or loss, or sensations of heat or cold intolerance. She has no remarkable past medical history other than seasonal allergies for which she takes cetirizine and fluticasone. The patient has no known medication allergies. Her physical examination reveals a girl of healthy weight with dark brown mildly hyperkeratotic variably-sized plaques over her anterior neck (Fig 1), the extensor surfaces of her upper and …