Exogenous ochronosis: Screening by dermoscopy and histopathological confirmation

A 51-year-old female presented with a 10-year history of brownish skin marks on her cheeks. Dermatological examination showed malar brownish macular lesions with diffused reddish areas and superimposing brownish papules. Further dermoscopic examination showed short circinate brownish-red structures and cutaneous pseudo-rete accentuation. Histopathological examination confirmed Stage II exogenous ochronosis (EO). Hydroquinone is the most commonly used topical agent for hyperpigmentation skin disorders. One side effect of its long-term use is EO. Clinically, EO is difficult to diagnose, and clinicians should be more aware of this condition. Dermoscopy is an in vivo diagnostic tool that is used to enhance the visualization of cutaneous lesions. The use of this device can potentially assist in identifying the progress of melasma disorder into EO.