A 39-year-old woman with spots covering her body.

To cite: Cowart D, Cowart KA, Hougeir FG. BMJ Case Rep Published online: [please include Day Month Year] doi:10.1136/ bcr-2013-201434 DESCRIPTION A 39-year-old African-American woman presented with a 12-year history of ‘itchy dark spots all over my body,’ excluding the face and acral surfaces. The lesions are slightly pruritic at baseline. Flares occur frequently, however, mostly with friction of drying off with a towel, resulting in urtication and increased pruritus of the skin lesions. The patient has similar flares with alcohol ingestion. The patient also reports chronic diarrhoea and headaches which began at approximately the same time she developed the skin lesions. Two previous colonoscopies and endogastroduodenoscopies were unremarkable. Evaluation by her primary care physician showed no identifiable cause for her headaches; a head CTwas unremarkable. The headaches were treated with naproxen, causing flushing and palpitations; a cardiovascular workup was unremarkable. She additionally has chronic ‘achy’ bone pain in her thighs.