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.
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