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Brown diseases comprise disorders leading to hyperpigmentation in skin and nails. Melasma is an acquired skin disorder that is characterized by brownish macules that typically occur on the face. Schamberg disease, also known as progressive pigmented purpura, is characterized by brown pigmentation with pepper spots on their edges. We summarize the epidemiology, pathogenesis, histologic features, and treatment choices for additional brown diseases, including melasma, pigmented purpuric dermatoses, postinflammatory hyperpigmentation, drug-induced hyperpigmentation, and pigmentations due to systemic or physiologic conditions.

Pigmented purpuric dermatoses (PPDs) are a group of idiopathic, chronic, and self-resolving conditions easily recognizable in adults but extremely uncommon in infants. We present the youngest patient with PPD reported to date.

A case is presented of a man with a 3-year history of ulcers in the setting of pigmented, annular and purpuric lesions of the lower extremities. A skin biopsy suggested a diagnosis of purpura annularis telangiectodes of Majocchi. First described in 1896 by Majocchi [1], purpura annularis telangiectodes is an uncommon pigmented purpuric eruption, which is characterized by symmetrical, purpuric, telangiectatic, and atrophic patches with a predilection for the lower extremities and buttocks. Histopathology and immunopathogenesis of this disease are similar to the other subtypes of pigmented purpuric dermatoses.

Three cases of unilateral pigmented purpuric eruption (UPPE) occurring in children aged between 7 and 12 years are reported. The lesions were asymptomatic and occurred on the lower limb and torso; one case demonstrated a quadrantic configuration with a sharp midline cutoff. The purpuric component resolved spontaneously within 3 months in all cases, while pigmentation showed partial resolution in the two cases followed up for 12 months. Our cases support previous reports of UPPE being a benign self-limiting condition mainly affecting young patients. The cause is unknown.

Summary Step aerobic classes are at present one of the most popular forms of exercise undertaken by young adults. To date no dermatological abnormalities have been described in people regularly performing step aerobics. We describe a case in which a healthy young woman developed an extensive pigmented purpuric eruption 4 weeks after commencing regular step aerobic classes. The eruption resolved completely 8 weeks after regular exercise was ceased.

We present four cases of a distinctive type of pigmented purpuric eruption occurring in a striking linear and pseudo-dermatomal distribution in young males. Whilst these cases share some of the clinical and histological features of other pigmented purpuric dermatoses, they are not readily classified with any of the entities so far defined in this group of disorders. We believe these cases represent a distinct group not previously described. Four patients with an unusual pigmented purpuric eruption are presented.

Background: Bioflavonoids and ascorbic acid have been shown to increase capillary resistance and to mediate potent antioxidative radical scavenging activities. Objective: We evaluated the clinical effect of oral bioflavonoids and ascorbic acid in patients with chronic progressive pigmented purpura (PPP). Methods: In an open pilot study, oral rutoside (50 mg twice a day) and ascorbic acid (500 mg twice a day) were administered to 3 patients with chronic PPP. Results: At the end of the 4-week treatment period, complete clearance of the skin lesions was achieved in all 3 patients. No adverse reactions were noted. All patients remained free of lesions at the end of 3 months after treatment. Conclusion: Our results suggest a beneficial effect of bioflavonoids in combination with ascorbic acid on PPP. Because the disease is mostly resistant to other treatment modalities, placebo-controlled studies are necessary to determine the usefulness of this therapy in PPP. (J Am Acad Dermatol 1999;41:207-8.)

• Cutaneous purpura In a patient with rheumatoid arthritis (RA) may cause concern to the managing physician because of the possibility of rheumatoid vasculitis or purpura due to qualitative or quantitative platelet defects from rheumatologic therapy. The pigmented purpuric eruptions are a group of chronic dermatoses of unknown causes that are characterized by clinical purpura and histologic capillaritis. We saw a patient with RA and a pigmented purpuric eruption. (Arch Intern Med1982;142:2184-2185)

To the Editor: The title "Transitory Pigmented Purpuric Eruption of the Lower Extremities'' has been given by Osment et al 1 to a condition which seems in every respect to be identical with the itching purpura described by me. 2 They remark that the latter condition, as well as the ``eczematid-like purpura'' of Doucas and Kapetanakis 3 (which I was at pains to differentiate from itching purpura), "more nearly conforms" to the clinical manifestations of the group they describe. I feel that this is an understatement and that an unprejudiced observer will agree that the symptoms, clinical and histologic pictures, laboratory findings, and even the response to corticosteroids in their condition and mine are the same. I had not intended to draw attention to this gross similarity had not the article in question been abstracted in the Year Book of Dermatology 4 ; the appropriate abstract 5 of my own article

To the Editor: I would like to answer Dr. L. J. Loewenthal's letter which appeared in the December, 1961, issue ofArchives of Dermatology. Dr. Loewenthal remarks that the eruption we described in our article, "Transitory Pigmented Purpuric Eruption of the Lower Extremities," seems to be the same disorder he had previously described as itching purpura. In all probability, the disorders are indeed the same, and, furthermore, are simply a variant of the group of pigmented purpuric eruptions including angioma serpiginosum, purpura annularis telangiectodes, peculiar progressive pigmentary disease, and pigmented purpuric lichenoid dermatitis. Even though these disorders are variants of a single pathologic process, it may be wise to continue to keep them separate in our thinking, since the prognosis is variable. We did not mean to suggest the title of the article for the name of the disorder. We presented our material because the condition has been singularly neglected

Introduction Four well-known clinical syndromes comprise the group of purpuric pigmented eruptions. 1 These consist of pigmented macular lesions involving predominantly the lower extremities. Additional variable characteristics include purpura, pruritus, atrophy, ulceration, and telangiectasia. We desire to describe a fifth entity which probably belongs to this group. It has been encountered by us more often than the combined total of the other four members. This entity does not appear to be clearly depicted in modern American dermatologic texts. Each of these five entities has distinguishing clinical characteristics, yet all have similar histopathologic features. However, we should like to emphasize that the clinical criteria for the clear-cut diagnosis of each member of this group are confusing, since many morphological features are shared. Pigmented Purpuric Eruptions Reports of the variable clinical features of (1) angioma serpiginosum (Hutchinson), (2) purpura annularis telangiectodes (Majocchi), (3) progressive pigmentary dermatitis (Schamberg), and (4) pigmented purpuric