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The use of the pulsed dye laser in a case of an occupationally acquired arteriovenous malformation

erythrocyte sedimentation rate hovered about 30–50 mm ⁄ h (normal range 0–20). A bone marrow aspirate showed hypocellularity with a few atypical megakaryocytes, and a trephine biopsy demonstrated a cellularity of 30% and fine fibrosis. Cytogenetic studies were normal. The final haematological diagnosis was hypocellular marrow. Dermatological features were multiple, discrete, darkbrown, longitudinal streaking of the finger and toe nails (Fig. 1b), with marked lentiginous, macular, buccal, lip and gum pigmentation. There was also pigmentation of the external genitalia. Interestingly, the patient reported that these pigmented areas either darkened or increased in number whenever her platelet count was lower than usual. This has however, not been verified clinically. The spontaneous occurrence of lenticular melanotic macular hyperpigmentation on the lips, oral mucosa and nails in the absence of associated systemic lesions was first reported by Laugier and Hunziker in 1970. This rare disorder usually begins in the third to fifth decade of life, is more common in women, and has been described almost exclusively in white populations. To date, its pathogenesis is unknown. Its importance lies in its similarity with the mucocutaneous pigmentary changes of Peutz–Jeghers syndrome, the difference being the absence of intestinal polyposis. Our patient has mucocutaneous features of Laugier– Hunziker syndrome together with persistent thrombocytopenia and a hypocellular marrow. It is possible that Peutz–Jeghers syndrome and Laugier–Hunziker syndrome are part of a spectrum of benign mucocutaneous pigmentary disorders, at one end devoid of internal associations, and at the other having important systemic manifestations, including bone marrow or intestinal abnormalities. This patient highlights the importance of excluding bone marrow disease and intestinal polyposis in patients with pigmented lips, mucosae and nails.