Unilateral ashy dermatosis occurring in a child

An unusual case of ashy dermatosis of Ramirez occurred in a 5-year-old-girl who had ash-colored hyperpigmented macules and plaques on the left leg and the left side of the trunk. These unilateral lesions showed histopathologic changes of a lichenoid tissue reaction. Although the exact cause of ashy dermatosis remains unknown, the positive test result for serum rheumatoid factor and the granular deposition of IgM at the dermoepidermal junction found in our case has immunologic implications.