Unusual Pigmentation of Legs

The patient is a healthy 51 yo woman with a 5 - 6 year history of asymptomatic progressive hyperpigmentation of the legs. She is in good general health and takes no medications by mouth. The process started on the calves and has spread proximally to the knees. She has rosacea in addition. She thinks her father has a similar problem.

O/E: Both legs from just above the ankles to the knees show punctate hyperpigmentation. The skin here has a slightly pebbly feel. Other than erythematous papules on both cheeks, the remainder of the cutaneous exam is normal. (There is no sclerodactyly, telangiectasas or sclerotic changes).

Photos:
Affected skin


Digital Zoom


Normal Skin (adjacent)


Dermoscopic Image


Lab: Biopsies of affected and normal skin were taken.

Diagnosis: Punctate Hyperpigmentation of the Legs. This does not look like the "salt and pepper" picture of scleroderma. Could this be an unusual genodermatosis?

Plan: Present to VGRD. Perhaps get serologies for scleroderma.

References: Nothing helpful found on PubMed.