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A 67-year-old woman presented after three years of progressive hyperpigmentation, which was worse in the sun-exposed areas of her skin but involved sun-protected areas as well.
Discussion
The answer is D: Nd:Yag laser treatment using 532 nm wavelength. Erythema dyschromicum perstans, commonly known as ashy dermatosis, was first described by Ramirez in 1957. This uncommon disorder occurs predominately in dark-skinned Latin Americans, particularly women in the first through third decades of life. Ashy dermatosis is a chronic condition characterized by asymptomatic, slate-gray or violaceous hyperpigmented macules distributed most commonly over the trunk and proximal extremities, and less frequently over the face and neck. Lesions, which occur in otherwise healthy persons, may initially present as erythematous macules that slowly progress to a blue-gray hue. The macules of erythema dyschromicum perstans vary in size and may occasionally demonstrate an erythematous raised border.1-3
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