Diffuse, Hyperpigmented Rash in an Adult.

Previously published Photo Quizzes are now featured in a mobile app. Get more information at http:// www.aafp.org/afp/apps. A 58-year-old man presented with generalized pruritus and an erythematous rash across his trunk, back, and extremities, including his palms and soles. The rash was not painful. Because of memory difficulties, he could not recall when the rash first appeared. He had no recent illness or fever. He had recently been evaluated for ataxia, upper extremity tremors, and hearing loss, and was presumed to have Parkinson disease. His medical history was significant for past alcohol abuse and placement of a pacemaker. He did not use intravenous drugs, and his wife was his only sex partner over the previous 16 years. He had areas of hypopigmentation across his distal extremities that were previously diagnosed as vitiligo. On physical examination, he was confused and had difficulty hearing. He was afebrile. The skin examination revealed an erythematous, f lat, maculopapular rash (Figures 1 and 2). There was no involvement of the gingiva or oral mucosa. Excoriations were present with areas of desquamation on the buttocks.