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A 54-year-old man with immunohistologically proven stage Ia cutaneous T-cell lymphoma (CTCL) was receiving trimethylpsoralen and ultraviolet A (PUVA) therapy for past eight months. The patient was initially given 8-methoxypsoralen (8-MOP), but he complained of excessive itching with this. After four doses, 8-MOP was successfully replaced with trimethylpsoralen, which the patient tolerated well. He also had scoliosis of the spine secondary to poliomyelitis since childhood. Cutaneous lymphoma responded well to PUVA therapy with complete resolution of lesions, both clinically and histologically. He denied regular sun exposure/ sun bathing. There was no previous history of PUVA or ultraviolet B (UVB) therapy. He had received a total of 746 J/cm2 of UVA over a period of eight months. One day, the patient noticed a few hypopigmented lesions on his trunk. Examination revealed diffusely tanned skin of the Fitzpatricks skin phototype V over the trunk, face, and extremities. Due to the scoliosis, the posture of the patient was slightly tilted to the right side and, because of this, there were several folds of skin on the right side of his trunk secondary to the abnormal posture. On attaining a straight posture, the skin hided within the folds, became visible, and that was considerably lighter in color compared to the surrounding exposed skin. He was explained about the cause and assured that the change in skin color he was referring to as new lesions was normal skin color. Subsequently, four months after the discontinuation of the PUVA, the difference in color between the skin folds and exposed skin became less, though was still perceptible.

Tanning caused by psoralen-photochemotherpy in Indian skin