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A healthy 34-year-old female bank employee presented with black discolorations of the skin on all her fingers. The discolorations had developed in the evening, after work. She was unable to remove the spots, even with the use of various abrasives. She had no other acute symptoms. The same symptoms had developed in some of her colleagues. What is the diagnosis?
Editor's note: We invite our readers to submit their answers at www.nejm.org/mystery. We will publish the diagnosis in the Correspondence section of the May 31 issue and e-mail it to everyone who submits an answer. All answers must be received by April 18.
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