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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.

image

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.)

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.)

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.)

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.)

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.)

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.

FIGURE 1-7.

Darkening of the extensor elbow, a normal variant that can be seen in darker skin.

FIGURE 1-8.

Medium brown pinpoint macules on the distal tongue, which can be present as a normal variant in individuals with pigmented skin.

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