Facial hyperpigmentation and crusted papules on the hands

Abstract

A 69-year-old woman with a history notable for lichen planus, breast cancer status post chemotherapy 7 years previously, and fibroid-related menorrhagia status post hysterectomy and bilateral oophorectomy 20 years previously presented with a 6-year history of facial hyperpigmentation and new painful, nonpruritic, blisters, erosions, and scabbing lesions on the backs of both of her hands. She had been taking ferrous sulfate 325 mg 3 times daily since her menorrhagia diagnosis 25 years previously. Exam revealed diffuse hyperpigmented patches on the face with hypertrichosis of the temporal region (Fig 1) and fragile skin with crusted papules on the dorsal aspect of both hands (Fig 2).