Intended for healthcare professionals

Endgames Spot Diagnosis

An unusual case of acquired facial pigmentation

BMJ 2020; 371 doi: (Published 28 October 2020) Cite this as: BMJ 2020;371:m3388
  1. Patrick Bryan, core medical trainee,
  2. Antonia Lloyd-Lavery, consultant dermatologist
  1. Department of Dermatology, Churchill Hospital, Oxford University Hospitals NHS Foundation Trust, Oxford, UK
  1. Correspondence to: P Bryan patrick.bryan{at}

A woman in her 70s presented to the dermatology clinic with a two year history of blue-grey hyperpigmentation on her face, which symmetrically involved her forehead, eyelids, cheeks, nose, and perioral skin (fig 1). Similar blue-grey discoloration was noted on her gingiva (fig 2).

Fig 1

Marked discoloration to the eyebrows, forehead, cheeks, and perioral skin

Fig 2

Blue-grey discoloration also involving the gingiva

The patient had had rosacea since her late teens, for which she had been taking oral minocycline intermittently for more than 20 years. Three months before this presentation she was advised to stop the minocycline because it was …

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