Acquired brachial cutaneous dyschromatosis: a common pigmentary disorder of the arm in middle-aged women.

We studied 20 Caucasian middle-aged patients, mostly women, who had asymptomatic, gray-brown patches with geographic borders, occasionally interspersed with hypopigmented macules, on the dorsum of the forearms, mostly bilaterally. The distal aspect of the arms was also involved in 2 patients; the face was always spared. Civatte's poikiloderma was associated with this hyperpigmentation in 9 patients. Epidermal atrophy, basal layer hyperpigmentation, elastosis and angiectases were histopathologic features. Pregnancy, menopause, local inflammation, and cosmetics were not predisposing factors. Undue sun exposure, oral contraceptives or estrogens were found only occasionally. Sixty-five percent of patients had hypertension and had been taking antihypertensive drugs, especially angiotensin-converting enzyme inhibitors, for years before pigmentation began. Acquired brachial cutaneous dyschromatosis (ABCD) is the suggested title of this disorder, which is not rare. Its prevalence in postmenopausal women, the hypopigmented macules, and the absence of a relation with estrogens, pregnancy, or hormone replacement therapy, all help to distinguish ABCD from melasma. An association with Civatte's poikiloderma as well as hypertension and/or antihypertensive drugs is suggested.