By Gary M. White, MD
Acquired brachioradial cutaneous dyschromatosis (ABCD) may be thought of as "melasma of the forearms".
Asymptomatic, irregular brown macules and patches on the dorsal aspect of the forearms is typical. Patients tended to be postmenopausal women, with types III-IV skin. Poikiloderma of civatte on the neck is frequently associated. Almost all cases are bilateral. In one patient, the shins were involved.
This condition most resembles melasma. In fact, for years I have called this "melasma of the forearms." Key differences are as follows: ABCD affects the arms, is seen primarily in postmenopausal women, and is unassociated with estrogens. In one report, a high percentage of patients have hypertension and were on ACE inhibitors [JAAD 2000;42;680].
Histologic examination shows a homogenous pattern of hyperpigmentation along the basal layer.
No treatment has yet been reported. Topical bleaching agents, e.g., hydroquinone 3-4% may be tried.
A similar darkening may occur on the upper back.
Dermatology Online Journal 17(10)