idiopathic eruptive macular pigmentation ( iemp ) is a rare skin disorder characterized by the presence of asymptomatic , brown pigmented macules that involve the face , trunk and proximal extremities in children and adolescents . the first description of this condition was given by degos et al . ,
these hyperpigmented macules gradually resolve over months or years without any residual pigmentation or scarring .
we report a case of a 10-year - old girl who fulfilled all the criteria for this entity .
a 10-year -old girl presented with asymptomatic brown macules over the trunk and proximal extremities , of three months duration .
they progressively increased in number and size over a period of one month and became stable .
the cutaneous examination showed multiple dark brown , discrete , round to oval macules and mildly elevated pigmented lesions over the anterior and posterior trunk and proximal extremities sparing the palms and soles [ figures 1 and 2 ] .
the individual lesion was 1 - 3 cm in diameter and the elevated lesions had a velvety appearance on the surface [ figure 3 ] .
the routine blood , urine and stool examinations , liver function , renal function and thyroid function tests revealed no abnormality .
biopsy from elevated lesion on back showed acanthosis , moderate papillomatosis and uniformly prominent melanin in the basal layer of the epidermis with normal number of melanocytes [ figure 4 ] .
no new lesions or change in preexisting lesions was seen at six months of follow - up .
dark brown discrete macules over the anterior trunk and proximal extremities characteristic macules on back velvety appearance of pigmented lesions acanthosis , papillomatosis and increased melanin in the basal layer ( h and e , 45 )
iemp is a rare skin disorder characterized by asymptomatic , brown macules involving the neck , trunk and proximal extremities .
though the first case was reported around 30 years back , the exact etiology and pathogenesis is still not known .
, in 1996 summarized the criteria for the diagnosis of this condition , namely ( a ) eruption of brownish - black , discrete , nonconfluent , asymptomatic macules involving the neck , trunk and proximal extremities in children and adolescents , ( b ) absence of any preceding inflammatory lesions , ( c ) no previous drug exposure , ( d ) basal layer hyperpigmentation of the epidermis with dermal melanophages without any basal cell damage or lichenoid infiltrate , and ( e ) normal mast cell counts .
the youngest and oldest case reported in the literature is that of a one - year - old and a 50-year - old .
the largest series of ten cases and nine cases have been described by jang et al .
the differential diagnosis of iemp includes post - inflammatory hyperpigmentation , fixed drug eruption , urticaria pigmentosa , lichen planus pigmentosus and erythema dyschromicum perstans .
iemp can be differentiated from these conditions by taking proper history and doing skin biopsy study .
histopathologically , iemp shows acanthosis , basal layer hyperpigmentation of the epidermis with dermal melanophages without any basal cell damage or lichenoid infiltrate and normal mast cell count .
some authors believe that iemp may be related nosologically to confluent and reticulate papillomatosis ( crp ) and eruptive acanthosis nigricans because both these conditions show histological findings of pigmented papillomatosis similar to our case . however , the clinical features and etiopathogenesis of these conditions are quite different .
it is important to consider iemp in the differential diagnosis of pigmentary lesions as iemp is a self - resolving condition .
the treatment of this condition is not required as spontaneous resolution of iemp is expected in a few weeks to few years . in our case ,
topical steroid was started for the first two weeks to speed up thinning of elevated velvety lesions but without any benefit . to include papillomatosis as one of the diagnostic criteria , more reports of iemp with papillomatosis
 we present a case of an otherwise healthy 10-year - old girl who presented with asymptomatic brown macules over the trunk and proximal extremities , of three months duration . 
 the cutaneous examination revealed multiple , dark brown , discrete , round to oval macules and a few mildly elevated lesions over the trunk and proximal limbs . 
 the individual lesion was 1 - 3 cm in diameter and a few showed velvety appearance over the surface . 
 darier 's sign was negative . 
 the histopathological study from the velvety lesion showed acanthosis , papillomatosis and increased melanin in the basal layer . 
 the upper dermis showed sparse perivascular infiltrate of lymphocytes without any dermal melanophages . 
 it fulfilled the criteria for idiopathic eruptive macular pigmentation with additional histological finding of papillomatosis . 
INTRODUCTION
CASE REPORT
DISCUSSION