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A 65 year old affican-american female presented with a complaint of darkening facial skin since the 1970's. At the time of presentation, she was using a "Ambi" cream. She had previously been treated for the hyperpigmentation with chemical peels and microdermabrasion without benefit. She took no exogenous hormones. The patient was otherwise well. Her review of systems was negative.
Physical Exam: hyperpigmented macules over cheeks, periorbitaly and perioculary.
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