Pigmented spots are finely reticulated to patchy in shape, initially light red. Later it turns to greenish gray to dark brown, mostly on the cheeks, back of the neck and other exposed areas, especially around the eyes and temporal zygomatic area is the most obvious, can be seen in congenital dyskeratosis, in the upper part of the trunk, neck, shoulders, face, abdomen and other places visible fine reticulated gray-brown pigmentation, velvet-like feeling. Also visible are skin atrophy, very pronounced capillary dilation, as if vascular atrophic skin heterochromia. The skin on the face is red and atrophic, and there may be irregular patches of pigmentation, extensive atrophy of the dorsal skin of the hands and feet with transparent shine, diffuse keratotic damage on the palms, plantars and knees and elbows, and easy formation of large blisters after trauma to the skin all over the body. Patients may sometimes have atrophic deformity changes of the skin, muscles and bones of the hands and feet. What is the differential diagnosis of fine reticulate to patchy hyperpigmentation? It should be differentiated from congenital cutaneous heterochromia and anhidrotic ectodermal dysplasia. Congenital cutaneous heterochromia Congenital vascular atrophic cutaneous heterochromia is characterized by skin atrophy, brown-red pigmentation, and capillary dilation with congenital cataracts. The onset of the disease begins within 3 to 6 months after birth with red edematous patches on the cheeks, in front of and behind the ears, on both sides of the buttocks, and on the extremities, followed by capillary dilation, dotted or reticulated pigmentation, interspersed with skin atrophy, depigmented spots, and other skin heterochromia changes. Some patients have corneal degeneration, sparse hair, eyebrows and eyelashes. About 25% of the patients have poor nail growth, rough and thick nail surface, longitudinal ridge, about half of the patients have congenital bone development defects or deformities, some patients have gonadal insufficiency, internal and external genital hypoplasia, males may have cryptorchidism, females have no Some patients have gonadal dysfunction, internal and external genital hypoplasia, cryptorchidism in males, and no menstruation in females. Ectodermal dysplasia without sweating Congenital ectodermal dysplasia is a group of complex congenital disorders with ectodermal defects that affect the skin and its appendages, teeth, pigment cells, eyes, ears, oral cavity and nasal mucosa, and occasionally the central nervous system, sometimes with other abnormalities. The classification is based on the presence or absence of defects in the hair, teeth, nails, and sweat glands, but the group is generally divided into anaplastic and sweaty ectodermal dysplasia based on whether the ectodermal glands are involved.