“…It phenotypically presents as pinpoint or peasized symmetrical mottled hypo-and hyperpigmented macules, typically in an acral distribution. There may be associated freckle-like macules on the face, extension of acral lesions proximally and lesions on the chest 3,4 . Onset of DSH is usually in infancy and childhood, with progression and eventual stabilization prior to adolescence and this lasts for life, however, Gaiewski 9 reported a late onset presentation, with acral lesions beginning at the age of 26 years.…”