HPI: A 42 years-old African American female presented with several years of plantar pits that are slightly tender and coarsened with keratin cores, which can be pulled off at times. She also noticed that over the past 10-20 years, she has developed increased asymptomatic freckle-like lesions on her axilla. Two punch biopsies were obtained, one from the right axilla and one from the left medial foot.
Past Medical History: Type 2 Diabetes
Family History: Her teenage daughter also started to have similar freckle-like lesions.
Social History: none
Physical Exam: Generalized follicular hyperpigmentation and freckle-like macules. Many dark brown reticulated, hyperpigmented macules on axilla, dorsal hands and feet. Some punctated keratotic pits on palmar crease and plantar surfaces (Fig 1-4).
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