Poikilodermatous Change of Skin: Diagnostic Insights from Clinical and Histopathological Examination

Poikilodermatous skin changes represent a diagnostic challenge due to their non-specific clinical features and broad differential diagnoses. This report presents the case of a 29-year-old female with symmetrical, variably pigmented macules and patches over sun-exposed areas, including the neck and upper limbs. Histopathological examination revealed epidermal atrophy, pigment incontinence, basal layer pigmentation, dermal telangiectasia and a mild lymphocytic infiltrate - findings consistent with poikilodermatous change. No features suggestive of interface dermatitis, atypical lymphoid cells or basal vacuolar alteration were observed, effectively ruling out conditions such as cutaneous T-cell lymphoma, connective tissue disease and lichen planus pigmentosus. In the absence of systemic symptoms or alarming histological features, a diagnosis of benign acquired poikiloderma, likely actinic in origin, was favoured. This case underscores the critical role of histopathological correlation in accurately diagnosing poikilodermatous lesions and guiding appropriate clinical management.