LAUSR

A 33-year-old Pakistani man presentedwithmultiple reddish, hypopigmentedmacules on his chest and back (Fig 1). The lesions appeared 20 years earlier and had progressively increased in number. Flattopped papules were present over his hands and shins (Fig 2). There was no growth on fungal culture from skin scrapings and no response to topical terbinafine treatment. His parents were cousins, but there was no family history of similar conditions. Blood tests, including a complete blood cell count, HIV, and lymphocyte subsets were normal. A histopathologic examination revealed acanthosis with hyperkeratosis and hypergranulosis. Keratinocytes appeared atypical, though not dysplastic, with an enlarged blue-grey cytoplasm (Fig 3).