LAUSR

A 5yearold boy presented for evaluation of hypopigmented lesions on the bilateral distal extremities present since birth. Past medical history was significant for attention deficit hyperactivity disorder (ADHD) and speech delay, and family history was noteworthy for similar hypopigmented lesions in the patient's father and paternal grandfather. Physical examination revealed numerous hypopigmented macules on the bilateral extensor and flexural forearms as well as the palms, soles, and ankles (Figures 1– 3, marked by asterisks). Scattered hyperpigmented macules were also identified on the flexural forearms, the palms, and the soles (Figures 2 and 3, marked by arrows). Additionally, circumscribed hyperkeratotic papules were identified on the palms and soles (Figures 2 and 3, marked by crosses).