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Vera M. R. Heydendael, MD, PhD; Rick Hoekzema, MD, PhD
Kennemer Gasthuis, Haarlem (Dr Heydendael), and Onze Lieve Vrouwe Gasthuis, Amsterdam (Dr Hoekzema), the Netherlands

Arch Dermatol. 2007;143(7):937-942.

	Since this article does not have an abstract, we have provided the first 135 words of the full text and any section headings.

REPORT OF A CASE

A 29-year-old woman presented with a 4-month history of a large, approximately 20x8-cm blue patch on her left forearm that had appeared overnight (Figure 1). She told us that she had noticed the blue patch after she had driven "nonstop" from Amsterdam, the Netherlands, to Spain in a state of rage after a fight with her partner.

Figure appears in full text version. Figure 1.

She had a several-year history of diabetes mellitus, for which she injected insulin. She used no other medications. A dissociative disorder had previously been diagnosed by a psychiatrist. Examination of the left forearm showed striking clear-blue dyschromia of the skin, without induration or any sign of trauma. A skin biopsy was performed (Figure 2).

Figure appears in full text version. Figure 2.

What is your diagnosis?

SECTION EDITOR: MICHAEL E. MING, MD, MSCE

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