Brown non-itchy smooth patches

[Riham_s]

Hello Doctor,
I deeply hope you can help me in my skin problem. I have a hyper-pigmentation problem. It all started two years ago (2008) I was 20 years old, I got a large irregular brown patch in my back, it's about 7 cm. It looks very much like a birth mark, I discovered it suddenly because it doesn't itch and it is smooth & painless. Then I discover more of these patches, I get a new one every several months. They remain in shape like the birthmarks do. The very first one is the biggest, and then the following ones get smaller & also darker. I now have a patch on my back, about 4 cm one at the back of my neck (photo attached), I got also several patches along the pelvis, small ones at the back of my knee.
since last year I am visiting a doctor in Gemrany. They suggested it could be Ashy dermatosis, but they are not sure. They prescribed for me a medicine named "skinoren" which is a cream that I use daily on the patches. I have been using it for about 2 month but there is no improvement. I take no medications, I eat healthy, I wonder what causes this disease.
I hope I described my case clearly. Please help me to understand what could be the reason, & what could be the treatment. It's very annoying & looks ugly
Thanks a lot in advance,
Riham

[Riham_s]

Thanks a lot for the reply. Actually most of the patches I have are NOT in the skin folds. I have a one in my back that is just down the shoulder in an unfolded area. In my neck as you see it is in the upper part & also in an unfolded area. Nevertheless, I will ask the dermatologist I visit about this possibility.

Well I checked on google images for "acanthosis nigricans" but they are not similar at all. Mine are like the photo posted, they always have irregular shapes & their shapes don't change with time.

I really hope to find a cure, and I also hope to know the reason because I am healthy otherwise. Knowing the reason is important for me to make sure no more new patches appear.
As I mentioned, the Dr suggested it to be Ashy Dermatosis. However the medication I am using (skinoren) hasn't shown any improvement. Since I know it is not a common disease in Germany & therefore there are not much studies on it, so I preferred to share my case on the net to see if any Dr on Medhelp has seen a similar case or if any patient with similar symptoms can help me.

I am really thankful for your sincere support and care. I will send any updates.

Thanks,
Riham

[Bhupinder Kaur, MD]

Hello,
From the biopsy report, acanthosis nigricans needs to be ruled out. It presents as symmetrical, hyperpigmented, velvety plaques mostly in the folds of skin. It is not itchy and is characterized by hyperpigmentation. My sincere advice is to consult a dermatologist and discuss this possibility with him.

It is very difficult to precisely confirm a diagnosis without examination and investigations and the answer is based on the medical information provided. For exact diagnosis, you are requested to consult your dermatologist. I sincerely hope that helps. Take care and please do keep me posted on how you are doing.

[Riham_s]

I would also like to mention that I have made a biopsy in the neck patch, and I will write down the report results.

"In part acanthotic epidermis with hypergranulosis. Orthohyperkeratosis focal vacuolar change in the basal layer and dyskeratotic cells. Band-like infiltrate of lymphocytes and eosinophiles. Melanin incontinence. In the PAS stain no fungal elements and no thickening of the basement membrane."

I hope I provided enough information which may help you get a better understanding of the case to help me in searching for a possible cause of this disease & a possible treatment (oral & topical). Please provide me with as much information as possible.

Thanks in advance,
Riham