LAUSR

Patient 1 was a 62-year-old woman (Figs 1, 2) with Fitzpatrick Type III skin, who presented with a 1-year history of asymptomatic textural change on the skin of her neck, upper arms and antecubital fossae. She had no history of excessive sun exposure and no preceding erythema. She was on no regular medication, and had no history of penicillamine use. She had no family history of skin disease. Ten years previously she had had undergone a curative hysterectomy and bilateral oophorectomy for uterine cancer, with no recurrence since treatment. Physical examination revealed a cobblestone appearance of the skin, consisting of small confluent yellowish papules resembling pseudoxanthoma elasticum (PXE). Results of an ocular examination were normal. Patient 2 was a 68-year-old Iranian woman, who presented with a 6-year history of similar skin changes. She had no medical history of note. She had previously been taking hormone replacement therapy for menopausal symptoms (oestradiol 2 mg and norethisterone acetate 1 mg once daily), which had been commenced before her skin symptoms appeared.