hyperpigmented scales followed by depressed depigmented patches

Hello,

I am a twenty-five year old African American female with a medical history significant for moderate adult onset acne and mild guttate psoriasis on my scalp, torso, and legs that is well-controlled with halobetasol proprionate .05% cream.  i am on no other medications or supplements.  during the summer, i noticed the development of some approximately round, rough, hyperpigmented spots on the back of my left upper arm starting in the cleft below the deltoid muscle and continuing upwards, and then a couple of similar spots appeared within a week or so on the same area of my right arm.  The largest spot is approximately two centimeters in diameter and the smallest spot is about three quarters of a centimeter in diameter and there are now 4 on my left arm and 2 on my right arm.  The hyperpigmented tissue was scaly and looked a somewhat like a scab, but softer.  In fact, it was so soft that with routine cleansing and no other manipulation of the area, the hyperpigmentation began to peel off, starting at the center, leaving a hypopigmented, slightly depressed (possibly) smooth area underneath.  The skin in these areas is as pliable as usual and there is normal hair growth.  There remains some scaly hyperpigmented tissue around the circumfrences of the lesion.  i've tried both antifungal and corticosteroid creams, but neither has worked.  I do not think the lesions are growing, but if they are, it is very slowly.  They do not itch or hurt, but I am worried about the spread of hypopigmentation or the consequences of having an untreated fungal infection.

Thank you.

Also, if it would be helpful, is there a way to post a picture of the lesions?

[Alan Rockoff, MD]

Very good presentation; if you aren't a medical student, you should be.

The best I can do with your description is to say that it may be a form of eczema, or it may be something more transient, like pityriasis rosea.  However, rashes like these can only be diagnosed in person, not on the internet.  I advise you to see a skin doctor in person, and to avoid therapy in the interim so as not to confuse the issue.

Best.

Dr. Rockoff