What Is Your Diagnosis?

Abstract

A 40–year-old woman referred to the dermatological clinic of Razi hospital with painful lesions on the axillae, between her breasts and intergluteal region since adolescence. The patient had been treated with a variety of antibiotics with only minimal improvement. The lesions reappeared with cessation of treatments. On cutaneous examination, multiple furuncle-like discharging nodules were observed over the axillae, between the breasts, buttock and gluteal region (figure 1). Other findings were giant black comedones and depressed scars which were found between the aforementioned lesions, particularly on her back (figure 2). A number of pits with 2 to 3 mm diameter were seen around the mouth (figure 3). Additionally, there were hyperpigmented macules in a reticular pattern over the axillae, inframammary area and groin (figure 4). Mucosal surfaces and nails were not pigmented. Systemic examination was normal. Laboratory data were all within normal limits. In familial history, one of her sisters, aged 50 years, had a similar pattern of pigmentation from the age of 20.