Can you crack this cutaneous clue?

A sprinkling of hyperpigmentation with a pinch of hypopigmentation

It took two seasoned rheumatologists in the UK to spot the disorder behind this salt-and-pepper skin.

Salt and pepper skin
The New England Journal of Medicine ©2021.

A 68-year-old man presented to their clinic with a five-year history of skin changes on his back and chest, according to the case report in the New England Journal of Medicine.

A smoker, the man had been