Taylor and Elbuluk's Color Atlas and Synopsis for Skin of Color

Chapter 1: Normal Variants in Pigmented Skin

INTRODUCTION

KEY POINTS

Pigmented skin can have alterations in pigmentation that can be considered normal variants.
These include mucosal as well as palmar and plantar macular pigmentation.
Nail plates may have vertical streaks of pigmentation.
Bony prominences such as elbows and knees can also have generalized darkening.
Embryologic lines of development can also lead to differences in the color of the dorsal versus ventral surfaces of the skin.

FIGURE 1-1.

Brown linear creases on the palm of a person with darker skin. (Reproduced with permission from Leal-Silva H. Predicting the risk of postinflammatory hyperpigmentation: The palmar creases pigmentation scale. J Cosmet Dermatol. 2021;20(4):1263-1270.)

Hyperpigmented palmar creases appear dark brown in color.

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FIGURE 1-2.

Atrophic brown punctate keratoses presenting linearly in the palmar creases of the digits. (Reproduced with permission from Taylor SC, Kelly AP, Lim HW, et al. Taylor and Kelly’s Dermatology for Skin of Color, 2nd ed. New York, NY: McGraw Hill; 2016, Figure 20-9C.)

Small hyperpigmented pits are formed in a linear fashion along the palmar creases of the fingers.

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FIGURE 1-3.

Numerous bilateral light to dark brown macules scattered on the plantar feet. (Reproduced with permission from Taylor SC, Kelly AP, Lim HW, et al. Taylor and Kelly’s Dermatology for Skin of Color, 2nd ed. New York, NY: McGraw Hill; 2016, Figure 20-9A.)

Many hyperpigmented macules ranging from light brown to dark brown are spread across the left and right plantar surfaces of the feet with the greatest concentration near the arches.

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FIGURE 1-4.

Faint light brown linear vertical streak on the nail plate of a person with darker skin. (Reproduced with permission from Taylor SC, Kelly AP, Lim HW, et al. Taylor and Kelly’s Dermatology for Skin of Color, 2nd ed. New York, NY: McGraw Hill; 2016, Figure 21-3.)

A hyperpigmented brown vertical band extends across the middle of the nail plate perpendicular to the cuticle in a person with darker skin.

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FIGURE 1-5.

Sharp linear demarcation of pigmentation on the posterior lower extremities with darker brown skin laterally and lighter skin medially consistent with type B pigmentary demarcation lines also known as Futcher lines. (Reproduced with permission from Burgin S. Guidebook to Dermatologic Diagnosis. New York, NY: McGraw Hill; 2021, Figure 1-6D.)

Darker pigmentation of the outer half of both the thighs and the legs on the dorsal side in a patient with pigmentary demarcation.

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FIGURE 1-6.

Increased pigmentation of the bilateral knees contrasting with the baseline skin color seen on the shins and dorsal feet. This is normal variant darkening, which can be seen in many individuals of color.