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A 35-year-old Japanese man with a 20-year history of psoriasis vulgaris, treated with topical corticosteroids and vitamin D3 analogues, cyclosporine, and psoralen plus ultraviolet A (PUYA) therapy, presented with multiple blue-grey, non-palpable patches on his back and upper arms. He had not noticed these lesions prior to PUVA therapy. Dermatological examination found multiple blue-grey, non-palpable macules, measuring 3-5 cm, on the back and upper extremities, with concomitant psoriatic skin changes (Fig. 1). These pigmented lesions did not affect the face, mucosa or eyes. The patient was also taking sodium valproate, and denied trauma. There was no family history of abnormal cutaneous pigmentation. Biopsy specimens from a blue-grey macule showed scattered, spindle-shaped dendritic cells containing many melanin granules in the upper and mid-dermis. On immunostaining for S-100 protein, spindle cells were positive. On electron microscopy, many mature melanocytes filled with stage IV melanosomes enclosed by an extracellular sheath were observed in the dermis of the pigmented lesion (Fig. 2), although there were also some melanophages containing melanosome complexes (Fig. 2a). Fig. 1. Clinical findings of acquired dermal melanocytosis. Poorly demarcated blue-grey macules on the back with concomitant psoriasis.

Acquired Dermal Melanocytosis Induced by Psoralen Plus Ultraviolet A Therapy