Pain and Hyperpigmentation of the Toes: A Quiz

Abstract

A 20-year-old female student, living in Rio de Janeiro, Brazil, developed well-delimited, asymptomatic, dark-reddish macules, on the distal phalanxes of the 3 first toes of her left foot (Fig. 1). The lesions appeared minutes after having put her shoes on, with an immediate sensation of burning. The shoes had been left outdoors overnight and she had observed an animal inside.The patient appeared to be in a good general state of health, with no palpable lymph nodes or vascular involvement. There were no signs and symptoms of systemic disease. Diagnosis was based on epidemiological factors, clinical examination and observation of the agent. Fig. 1. Clinical presentation of the skin lesions: well-delimited, asymptomatic, dark-reddish macules, on the distal phalanxes of the 3 first toes of the left foot.

Pigmented Macule on the Sole Probably Caused by a Stink Bug

“…The characteristics of pigmentation caused by a millipede are sudden appearance of a black or brownish spot, usually on the feet, along with local pain, burning sensation and paraesthesia ( 7 ). Pigmentation disappears in a few weeks or months ( 8 ). In the current case, a pigmented macule appeared suddenly, as in the case of a pigmented spot caused by a millipede.…”