Hyperpigmented Plaques on the Feet.

Previously published Photo Quizzes are now featured in a mobile app. Get more information at http:// www.aafp.org/afp/apps. A 33-year-old man presented with asymptomatic blue-gray lesions on both feet. The lesions started developing six months earlier, getting darker and larger over time. He was using naproxen, tretinoin cream (Retin-A), and oral minocycline (Minocin). Physical examination revealed coalescing, blue-gray, pinpoint papules and plaques on the distal dorsal, medial, and lateral surfaces of the feet (Figures 1 and 2). The lesions were nonblanching and nontender to palpation. Biopsy of the papules showed diffuse pigmentation of the dermis with distinct dark granules within macrophages.