Dermatology: Practical and Conceptual Image Letter | Dermatol Pract Concept. 2022;12(2):e2022106 1 Dermatology Practical & Conceptual Case Presentation A 66-year-old male presented with pigmented lesions that he had for a few months. Diagnosis of erythema dyschromicum perstans was made based on clinical appearance (asymptom- atic, blue-grayish patches of varying sizes, some with ery- thematous borders, distributed on the face, arms, shoulders and trunk) (Figure 1 A-D), histopathology (atrophic epider- mis, superficial and perivascular lymphocytic infiltrate and pigment incontinence in the dermis) (Figure 1E) and dermos- copy (gray-bluish small dots over a bluish base) (Figure 1F). Teaching points In everyday practice and for every skin lesion, the use of der- moscopy as a supportive tool is highly recommended. In a case of erythema dyschromicum perstans (EDP), there are A Case of Erythema Dyschromicum Perstans Ana Ravić Nikolić1,2, Vesna Miličić1,2, Bojana Jovović Dagović2, Slobodanka Mitrović3,4 1 Department of Dermatovenereology, Faculty of Medical Sciences, University of Kragujevac, Kragujevac, Serbia 2 Department of Dermatology, University Clinical Center Kragujevac, Kragujevac, Serbia 3 Department of Pathology, Faculty of Medical Sciences, University of Kragujevac, Kragujevac, Serbia 4 Department of Pathology, University Clinical Center Kragujevac, Kragujevac, Serbia Citation: Ravić Nikolić A, Miličić V, Jovović Dagović B, Mitrović S. A Case of Erythema Dyschromicum Perstans. Dermatol Pract Concept. 2022;12(2):e2022106. DOI: https://doi.org/10.5826/dpc.1202a106 Accepted: November 4, 2021; Published: April 2022 Copyright: ©2022 Ozarslan et al. This is an open-access article distributed under the terms of the Creative Commons Attribution- NonCommercial License (BY-NC-4.0), https://creativecommons.org/licenses/by-nc/4.0/, which permits unrestricted noncommercial use, distribution, and reproduction in any medium, provided the original authors and source are credited. Funding: None. Competing interests: None. Authorship: All authors have contributed significantly to this publication. Corresponding author: Ana Ravić Nikolić, MD, PhD, Department of Dermatovenereology, Faculty of Medical Sciences, University of Kragujevac, Kragujevac, Serbia. E-mail: anaravic74@gmail.com significant clinical, histological and dermoscopic similarities between EDP and other acquired dermal macular hyperpig- mentations-pigmented contact dermatitis and lichen planus pigmentosus [1]. Viney et al reported that severity of pigmen- tation by dermoscopy is comparable with severity of clinical and histological findings but there are no specific dermo- scopic differences to differentiate these diseases [1,2]. Four dermoscopic grades were observed: 1) discrete pigment dots without any pattern; 2) pigment dots and globules arranged in broken net pattern; 3) pigment dots and globules in a well- formed net-like pattern and 4) diffuse pigment dots, globules and blotches, sparing only gland openings [1]. According to the given classification, first grade corresponds to our case. Presence of dots, globules and blotches in EDP differs from other hyperpigmentations, such as melasma where pseu- do-reticular network is observed or in the case of nevus Ota where slate-gray structureless areas are present [1]. 2 Image Letter | Dermatol Pract Concept. 2022;12(2):e2022106 References 1. Vinay K, Bishnoi A, Kamat D, Chatterjee D, Kumaran MS, Parsad D. Acquired dermal macular hyperpigmentation: An update. Indian Dermatol Online J. 2021;12(5):663-673. DOI: 10.4103/ idoj.IDOJ_881_20. PMID: 34667751. PMCID: PMC8456249. Figure 1. (A- D). Blue-grayish patches of varying sizes, some with erythematous borders localized on the face, arms, shoulders and trunk. (E) Atrophic epidermis, superficial and perivascular lymphocytic infiltrate and pigment incontinence in the dermis (H&E x100). (F) Dermoscopic image: gray-bluish small dots over a bluish base (Dermatoscope Heine Delta 20 Led Plus). 2. Sasidharanpillai S, Govindan A, Ajithkumar K, et al. Histologi- cal evaluation of acquired dermal macular hyperpigmentation. Indian Dermatol Online J. 2019;10(5):542-546. DOI: 10.4103/ idoj.IDOJ_426_18. PMID: 31544073. PMCID: PMC6743398.