Cutaneous Markers in Ochronosis

Sir, A 40-year-old woman presented with low backache of five-year duration with pain in the knee, shoulder and ankle joints on both sides. On examination she was found to have thickened ear lobule with restricted mobility of pinna [Figure 1]. There was black pigmentation in the palmar aspect of the right index finger [Figure 2]. She also had hyperpigmented plaques with adherent scales in the left palm which was most obvious in the little finger [Figure 3]. Plain radiograph of the lumbar spine showed intervertebral disc calcification [Figure 4]. Her urine sample collected in the outpatient turned black on standing for about 12 h. She was diagnosed to have ochronosis and was positive for urine HPLC (high profile liquid