Intended for healthcare professionals

Endgames Spot Diagnosis

Hyperpigmentation in the skin folds

BMJ 2018; 360 doi: (Published 18 January 2018) Cite this as: BMJ 2018;360:j5729
  1. Xiao Ke Liu, dermatologist,
  2. Jun Li, dermatologist
  1. Department of Dermatology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
  1. Correspondence to Jun Li, lijun35{at}

A 62 year old man presented with a one year history of asymptomatic hyperpigmentation of the flexural and intertriginous areas, especially in the groin (fig 1). He had thickened skin on his palms, feet, and neck, had lost 15 kg in three years, and had experienced nail dystrophy (melanonychia and onychoatrophy) for two years. He had recently received a diagnosis of unexplained hypothyroidism and hypogonadism. What is the most likely diagnosis?

Fig 1

Hyperpigmented, velvety skin lesions in the groin

Short answer

Acanthosis …

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