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Case Reports

Abstract

Acquired ichthyosis (AI) is a nonhereditary cutaneous disorder characterized by dry, rough skin with prominent scaling that may involve different body portions. AI is usually associated with neoplastic, metabolic, endocrine, autoimmune processes, infectious diseases, and medication use. Determining the underlying reason for AI can be challenging and often requires a detailed work-up. A 63-year-old man with a history of severe refractory cavitary and highly drug-resistant Mycobacterium avium complex (MAC) infection since 2017 was referred to our clinic with a complaint of bilateral hyperpigmented scaling on their forearms. The patient’s history was significant for various multiple antimicrobial therapies, including azithromycin, amikacin, and clofazimine, without clearance of the infection. Furthermore, the physical examination also noted ichthyosiform changes involving the legs in addition to the arms and a hyperpigmented lesion on the chest. A shave removal of a chest lesion showed a partially regressed atypical melanocytic proliferation with spindle cell features, suggestive of invasive malignant melanoma with regression. The patient was later scheduled for surgical removal. Here, we present a patient with acquired ichthyosis, which might have been caused by the patient's medication, clofazimine, or regressing melanoma, considering the neoplasm might have been present long enough to cause ichthyosiform changes. We present this case to emphasize the importance of possible paraneoplastic processes that may cause AI, regardless of any previously known triggering factors.