Question: Derm

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You are seeing a 12-year-old girl with a 5 week history of discoloration on her anterior neck. There are brown, slightly raised plaques that appear like dirt. She has tried scrubbing with various soaps without any improvement. A clinic doctor gave her steroid creams but these did not help. She is not overweight and recently had a normal screening Hemoglobin A1C. She has no history of prior rash of any kind.