Macular amyloidosis with widespread diffuse pigmentation

We report two patients with an unusual variant of macular amyloidosis who had diffuse homogeneous hyperpigmentation without papules, a rippled pattern or poikiloderma. The hyperpigmentation was extensive, involving the face, neck, mucosa, axillae, groin and peripheries in one patient and only the face and arms in the other. Skin biopsies in both cases revealed subepidermal band-like amyloid deposits. Neither patient had systemic involvement. The skin lesions in these patients could be easily confused with hyperpigmentation caused by endocrine disorders, drugs, heavy metals, polychlorinated biphenyl or cutaneous inflammation.