A 14-year-old female presented with reticulate pigmentary changes since the age of 4 years. Initially, the lesions were present only over the fingers and gradually they increased in size as well as number to attain the present status. Cutaneous examination revealed sharply demarcated atrophic hyperpigmented macules over the dorsum of extremities and upper as well as lower eyelids of both sides. Another important finding was presence of palmar pits and breakage of epidermal ridge pattern (Fig. 1 to 3). There wasn’t any hypopigmented lesion anywhere. Chest, abdomen, lower extremities and flexures were spared. Examination of hair, nail and mucosa did not reveal any abnormality. Our patient’s mother had similar lesions. Skin biopsy from a hyperpigmented macule over the dorsum of hand showed increased melanin in the basal layers. Based on these findings, a diagnosis of Reticulate acropigmentation of Kitamura was done. Important clinical differential diagnoses include dyskeratosis congenita (poikiloderma, leukoplakia and nail dystrophy), Dowling Degos (reticulated hyperpigmentation of major flexures, comedones on the back and neck and pitted facial scars), dyschromatosis symmetrica hereditaria (symmetrical dyschromatosis of distal extremities, especially dorsal aspects of hands and feet but palms, soles and mucous membranes are spared), dyschromatosis universalis hereditaria (generalized hyper-and hypopigmented macules; can occur on palms and soles, but not mucous membranes).

Fig. 1 Hyperpigmented macules on face.

Fig. 2 Hyperpigmented macules on dorsum of hands.

Fig. 3 Palmar pits and broken epidermal ridge pattern.