History:

This is the mucosal pigmentation of Addison's disease.Pigmentation also occurs in sun exposed areas of the skin and areas of pressure or trauma.Involvement of the palmar creases is a characteristic feature.Addison's disease can have many causes including tuberculosis,bilateral metastases and can also be part of a polyglandular autoimmune disease.

Patients become progressively  weak with increasing hypotension and hyperpigmentation.