The histopathological features of cutaneous
hyperpigmentation in
Addison disease have very occasionally been reported, and they include acanthosis, hyperkeratosis, focal
parakeratosis, spongiosis, superficial perivascular lymphocytic infiltrate, basal
melanin hyperpigmentation, and superficial dermal melanophages. We present a study on 2 biopsies from the arm and the thigh in a 77-year-old woman with a long clinical history of
Addison disease as well as senile
purpura and
alopecia of female pattern. The patient presented diffuse
hyperpigmentation of the skin, more pronounced on her face, and left upper forehead. The skin biopsies showed no remarkable dermal inflammatory infiltrate with melanocytic
hyperpigmentation of the basal layer of the epidermis as well as a mild amount of melanophages in the papillary dermis. In addition, we found
lipofuscin in the
luminal pole of the secretory epithelium of the eccrine glands. In the perieccrine areas, there was Perls-positive pigment in the cytoplasm of macrophages most likely related to the senile
purpura. An immunohistochemical study with
Melan-A showed a melanocyte/keratinocyte ratio of 1:20 (5%) in the arm and of less than 1:50 (only 2 melanocytes in the whole section; <2%) in the thigh.