- An otherwise healthy man in his 40s presented with white macules and patches that appeared on his skin several years ago. Initially, he noticed asymptomatic white discoloration on the ventral aspect of wrists, with subsequent involvement of thehead and neck. He had no relevant medical, drug, or family history, except for thyroid dysfunction in his mother. He worked in a laundry facility, with frequent exposure to detergents. Examination revealed well-demarcated hypopigmented patches without erythema or scaling on the ventral forearms (Figure 1).
- A 34-year-old female patient presented with painful erythematous papules on both hands and feet. The lesions appeared in late December and were increasing in number by the time she was evaluated in early spring. She was at 19 weeks of pregnancy, with no other new symptoms or relevant medical or drug history. On dermatologic examination, multiple mildly tender violaceous papules were noted bilaterally on tips of acral surfaces (Figure 1). No ulceration or necrosis was observed.
- A 57-year-old man presented with a 1-year history of yellowish discoloration and increased brittleness affecting his fingernails and toenails, with spontaneous avulsion of left toenail. On review of systems, he reported a history of progressive shortness of breath, fatigue, and chronic cough of 2 years duration, with unintentional weight loss. He denied use of tobacco or other drugs. Dermatological examination revealed diffuse yellow discoloration of all fingernails and toenails (Figure 1). Nail clipping sent for Grocott-Gömöri silver (GMS) staining showed negative results for fungal hyphae, excluding onychomycosis.