A 67-YEAR-OLD CAUCASIAN WOMAN came to the diabetes center for a routine check-up. She indicated that her face and eyes had become discolored, and that the discoloration had occurred gradually. She denied pruritus, erythema, edema, or pain at the site, and reported no vision changes, dry eyes, or other constitutional signs and symptoms. She did not smoke.
Th e patient’s past medical history was significant for type 2 diabetes, hypertension, depression, dyslipidemia, and rosacea. The medications she was taking included pioglitazone, metformin, coral calcium, glyburide, atorvastatin, fosinopril, and minocycline.
On physical exam, there was a bluish pigmentation of the left lateral forehead and cheek (FIGURE 1A) and bluish pigmentation of the sclera (FIGURE 1B). The rest of her exam was normal.
We were concerned about venous dilation, and ordered a computed tomography scan of the chest and an ultrasound of the neck. Both were normal, thus ruling out a thoracic outlet obstruction.
FIGURE 1
Unusual pigmentation of forehead and eyes
This 67-year-old woman said that the bluish discoloration of her face and eyes had come on gradually. She had no problems with her vision and no pain in her eyes.
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HOW WOULD YOU TREAT THIS PATIENT?