History:

Large, well-demarcated, hyperpigmented patches covered with bran-like scales distributed over the trunk and the shoulder area. The patient suffered rash exacerbation every summer for last three years. The rash was asymptomatic but the patient was bothered by cosmetic appearance. A useful aid to diagnosis is the exaggeration of the scaly nature of the rash by scratching or even stretching lesional skin as this was evident in the shoulder lesions.