Acquired brachial cutaneous dyschromatosis in a 60-year-old male: a case report and review of the literature

Abstract

Acquired brachial cutaneous dyschromatosis is an acquired pigmentary disorder that has been described in only 20 patients but likely affects many more. This case of a man with acquired brachial cutaneous dyschromatosis is unique as most reports are in women. We report the case of a 60-year-old male who presents with an asymptomatic eruption characterized by hyperpigmented and telangiectatic macules coalescing into patches on the bilateral extensor aspects of the forearms which is consistent clinically and histopathologically with acquired brachial cutaneous dyschromatosis. Given its presence in patients with clinical evidence of chronic sun exposure and its histopathological finding of solar elastosis, acquired brachial cutaneous dyschromatosis is likely a disorder caused by cumulative UV damage. However, a possible association between angiotensin-converting enzyme inhibitors and acquired brachial cutaneous dyschromatosis exists. Further investigation is needed to elucidate both the pathogenesis of the disorder and forms of effective management. Treatment of the disorder should begin with current established treatments for disorders of dyspigmentation.

Figure 1

Clinical presentation of acquired brachial cutaneous dyschromatosis. There are irregular hyper- and hypopigmented macules coalescing into large patches on the bilateral dorsal forearms.

Figure 2

Clinical presentation of acquired brachial cutaneous dyschromatosis. Closer inspection of the left forearm reveals hyperpigmented patches and hypopigmented, slightly depressed, atrophic plaques with prominent telangiectasia. Note the relative sharp demarcation at the distal forearm/wrist.

Figure 3

Histopathological examination of acquired brachial cutaneous dyschromatosis. Note the pronounced atrophy of the viable epidermis and papillary dermis, increased telangiectasias, abundant solar elastosis, and scattered melanophages, consistent with ABCD 100x magnification, H&E.