A 25-year-old female presented with a 10-year history of intermittent black secretions from bilateral malar cheeks. The discharge occurred mostly following physical exertion, emotional distress, and an increase in ambient temperature. The patient’s other bodily secretions were of normal color. Her medical history was otherwise unremarkable. In particular, she was not on any topical or oral medications. The family history was negative for similar symptoms or alkaptonuria.
Physical examination. Findings revealed dark stains in bilateral malar areas. The patient wore no makeup. Examination after 10 minutes of exercise showed small black beads of sweat over the malar eminences. Upon pressure on the cheeks, a dark fluid with no odor was expressed. The rest of the examination was unremarkable.
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