Recognizing Physiologic Pigmentation in Skin of Color: A Narrative Review

Nonpathologic patterns of cutaneous pigmentation are a common concern among individuals with skin of color (SOC). However, many healthcare providers, particularly dermatologists, report having inadequate training in how to recognize and treat the unique cutaneous pigmentation concerns of their patients with SOC. Although variations in physiologic pigmentation are usually benign differences in skin tone arising from increased melanin production, many individuals—particularly those with SOC—may be concerned about the cosmetic appearance of pigmentation variations or feel that they indicate disease. Therefore, the ability to recognize and differentiate benign versus pathologic physiologic pigmentation is crucial for dermatologists to avoid unnecessary diagnostic tests and treatments and to provide accurate, equitable, and patient-centered care to patients with SOC. In this narrative review, we summarize the most common patterns of benign physiologic pigmentation seen in the skin, nails, and oral and genital mucosa that may be of particular concern for patients with SOC. Our aim is to provide clinicians with a comprehensive overview of benign physiologic pigmentation patterns to prevent misinterpretation of these normal findings as pathologic.