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An elderly woman presented with 6 months history of skin coloured to erythematous papules in annular pattern over extremities, upper back and neck. The patient was diagnosed with granuloma annulare (GA) and started on hydroxychloroquine (HCQ) 300 mg daily. After 4 months of treatment, she developed bluish grey pigmentation within the plaques of GA with normal surrounding skin (figure 1A,B). There was no pigmentation at other body sites. Biopsy from the plaque showed necrobiotic collagen with intradermal mucin and perivascular lymphohistiocytic infiltrate accompanied by brown coarse pigment in the dermis …
Contributors VT, AD and MSK had full access to all the data in the study and take responsibility for the integrity of the data and the accuracy of the data analysis and were responsible for the study concept and design. VT and SK drafted the manuscript. BDR and DA contributed to the critical revision of the manuscript for important intellectual content and supervised the study. All authors contributed to the acquisition, analysis and interpretation of data.
Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.
Competing interests None declared.
Patient consent Not required.
Provenance and peer review Not commissioned; externally peer reviewed.
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