A 76-year-old male patien...

A 76-year-old male patient with a history of Restless leg syndrome was prescribed rotigotine patch 2 mg/24 hours for the treatment of his symptoms. He had been using the patch for 4 months without any adverse effects. However, he noticed the appearance of skin lightening on bilateral anterior shoulders near the site of the patch application. His other medical history included polymyalgia rheumatica, depression, chronic idiopathic pruritus, hypertension, hyperlipidemia, atrial fibrillation, as well as cutaneous squamous cell carcinoma and basal cell carcinoma. He was also taking prednisone 10 mg daily, oxycodone, dabigatran, lisinopril, pregabalin, furosemide, atorvastatin, and fluoxetine. Physical exam showed sharply demarcated depigmented patches on the bilateral anterior shoulders. Melan A-positive melanocytes were retained at the edge of the biopsy. The patient was not bothered by the depigmentation and chose to continue the rotigotine patch for his RLS. He was instructed to rotate the patch among other areas (abdomen, thigh, hip, flank, shoulder, or upper arm), as recommended in the rotigotine package insert.