not-yet-known not-yet-known not-yet-known unknown Case Presentation A 51 years female presented with multiple asymptomatic reticular hyperpigmented macules which appeared first on flexor aspect of elbow and progressed to involve other flexural parts of the body (Figure 1 a,c ). Skin lesions were present since the age of 25 and pigmentation aggravated since last 4 years.There is history of similar lesions in her mother, brother, her son and daughter (Figure 2 pedigree chart). Her daughter with the lesions showed some features of downs syndrome such as a short neck, smaller hands ,feets, ears and protruding tongue. On examination of the case, multiple brown to black colored macules of 2-4 mm in diameter arranged in reticular pattern distributed symmetrically over face,chest, inframammary region, axilla ,elbow and groin. Longitudinal melanonychia was observed in right index finger along with perioral pitted scars (Figure 1 b).However, comedones like lesions were not present in our case.