Bluish-grey pigmentation of the facial skin and lower legs.

A 77-year-old woman was referred to our outpatient clinic because of bluish-gray pigmentation of the facial skin and lower legs (figures 1A and 1B). Her medical history revealed hypertension, hypercholesterolaemia and chronic obstructive pulmonary disease Global Initiative for Chronic Obstructive Lung Disease (Gold) classification 3. Home medication included metoprolol, barnidipine, irbesartan, omeprazole and gemfibrozil. Her COPD medication included acetylcysteine, inhaled steroids, short-acting beta-agonists and anticholinergics. Due to recurrent disease exacerbation complicated by bronchiectasis, she had additionally been taking prophylactic minocycline 100 mg/day for the past two years. On physical examination the patient had a temperature of 36.7°C and diffuse ronchi in both lungs. Skin examination revealed blue-grey hyperpigmentation in the zygomatic region, nose and lower legs. She had no lymphadenopathy. Laboratory findings showed a subclinical hypothyroidism. Complete blood counts, inflammation parameters, liver and kidney function tests were not remarkable.