There is a critical need for tailored photoprotection in skin of color (SOC) populations. SOC has higher eumelanin-to-phenomelanin ratios, more mature melanosomes, and enhanced DNA repair capacity compared with lighter skin. The quantity and distribution of melanin in darker skin provide natural photoprotection. This leads to a misconception that SOC populations are inherently protected from all photodamage and serves as a barrier to proper photoprotection for these populations. Although the skin cancer incidence is lower in dark skin, mortality is higher, perhaps as a result of late diagnosis or misdiagnosis. These populations are still susceptible to skin damage from ultraviolet (UV) radiation, resulting in exacerbation of various dermatologic conditions, including pigmentation disorders, photodermatoses, and skin cancer. This review aims to comprehensively examine the photoprotection needs for SOC populations, addressing gaps between physiological characteristics and clinical outcomes, evaluating current photoprotection practices, examining educational implications, and considering future directions for photoprotection for SOC. A literature search was performed using PubMed and Google Scholar. The search was conducted from database inception through July 15, 2026. Articles were included if they addressed photoprotection, photodamage, photoaging, pigmentary disorders, photodermatoses, or skin cancer in SOC populations. Visible light (VL) and long-wave UVA1 are significant contributors to pigmentary alteration in SOC. The major drivers of pigmentation in SOC and photodamage can manifest as pigmentary disorders, particularly melasma and post-inflammatory hyperpigmentation (PIH), photoaging, photodermatoses, and skin cancer risk. Comprehensive photoprotection strategies for individuals with SOC include behavioral sun avoidance measures, sun-protective clothing, avoiding harmful behaviors, and community-based education programs. Sunscreen formulations for SOC should be tailored to skin phototype (SPT), with an SPF of 30 and broad protection that covers UVA, VL, and infrared A to limit hyperpigmentation and photoaging. Iron oxide-containing sunscreens provide VL protection and reduce white cast. Niacinamide-containing sunscreens are helpful for reducing PIH. Since UV and VL generate reactive oxygen species (ROS) that promote inflammation and persistent PIH, antioxidants in sunscreen are important in SOC to neutralize this damage and support DNA repair. Comprehensive photoprotection is essential for SOC populations. SOC individuals face unique manifestations of photodamage. Effective photoprotection in SOC requires extension beyond traditional UVB protection to meet the specific needs of SOC. Additionally, targeted education, community engagement, and barriers to care need to be addressed to improve outcomes. It is important for the dermatology community to commit to inclusivity and advocate for equitable access to photoprotection resources for all.

Background Pigmented contact dermatitis (PCD) is a pigmentary variant of contact dermatitis characterized by gradually developing facial hyperpigmentation with minimal or absent overt dermatitis. Owing to its close resemblance to other causes of facial melanosis, PCD is frequently underdiagnosed. Patch testing plays a crucial role in identifying causative allergens and guiding avoidance-based management. Objectives To evaluate the clinical profile, dermoscopic features, and patch test allergen spectrum in patients with PCD attending a tertiary care hospital. Methods This prospective observational study was conducted over a period of 1.5 years in the Department of Dermatology, Santosh Medical College and Hospital, Ghaziabad. A total of 55 patients clinically diagnosed with PCD and fulfilling inclusion criteria were enrolled after informed consent. Detailed demographic and clinical data were recorded using a structured proforma. Dermatoscopic examination was performed using a DermLite DL5 dermoscope (DermLite LLC, Aliso Viejo, CA). Patch testing was carried out using the Indian Standard Battery and Indian Cosmetic Series, with readings taken at 48 hours, 96 hours, and on day 7, interpreted according to ICDRG criteria. Statistical analysis was performed using IBM SPSS version 27.0. Results The majority of patients were women (n=41; 74.5%), with the commonest age group being 31-40 years (n=23; 41.8%). Brownish-black pigmentation was the predominant clinical presentation. Dermatoscopy most frequently revealed brownish-gray background pigmentation, brown and gray globules, and follicular plugs with perifollicular white halos. Patch test positivity to at least one allergen was observed in 43 (78.2%) patients. Paraphenylenediamine (n=16; 27.1%) was the most common allergen, followed by cetrimide (n=9; 15.3%) and lavender absolute (n=7; 11.9%). Hair dye was the most frequent exposure source associated with allergen positivity. Conclusion: PCD predominantly affects young to middle-aged females and is strongly associated with cosmetic and hair dye exposure. Patch testing is an essential diagnostic tool for identifying relevant allergens and enabling effective prevention through targeted avoidance.

Acquired bilateral naevus of Ota-like macules (ABNOM), also known as Hori's naevus, is a common dermal melanocytosis causing facial hyperpigmentation. While the 755-nm Q-switched alexandrite lasers (QSAL) are traditionally used, they are limited by moderate clearance and substantial risk of post-inflammatory hyperpigmentation (PIH). This systematic review and meta-analysis evaluate the efficacy and safety of the 755-nm picosecond alexandrite laser (PSAL) for ABNOM. Embase via Ovid, MEDLINE, PubMed, Scopus, Cochrane, Web of Science and CiNAHL were searched from inception to April 14, 2026, according to Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) guidelines. The review was prospectively registered on PROSPERO (CRD420261379083). Studies reporting efficacy or safety outcomes following PSAL treatment for ABNOM were included. Statistical analyses were performed using a random-effects model. Six studies comprising 318 patients (94.6% female, predominantly Fitzpatrick skin types III-IV) were included. After excluding studies at critical risk of bias from quantitative pooling, the pooled first-session near-complete (> 90%-95%) clearance rate was 8.8% (95% CI 5.9%-12.7%; I[2] = 0%). Clearance rates improved progressively with additional sessions. The overall pooled PIH rate was 21.1% (95% CI 17.1%-26.1%; I[2] = 0%), with all cases being transient. Hypopigmentation (0.6%) and scarring (0%) were rare. Numerically lower PIH rates were observed in the paediatric cohort (16.3%) compared with adults (22.2%). PSAL provides an effective treatment for ABNOM with progressive pigment clearance over multiple sessions and a favourable safety profile. Multiple sessions are typically required for optimal results. Further high-quality RCTs with standardised protocols and long-term follow-up are warranted.

Lasers and energy-based devices are integral to the management of dermatologic conditions, including pigmentary disorders, tattoo removal, vascular lesions, acne scarring, treatment of photoaging, and hair removal. In skin of color (Fitzpatrick types IV-VI), increased epidermal melanin acts as a competing chromophore with a broad absorption spectrum, increasing the risk of adverse effects such as post-inflammatory hyperpigmentation, hypopigmentation, blisters, and scarring. This review synthesizes current evidence on device selection, parameter optimization, and risk mitigation strategies to maximize safety and efficacy in this population. Low-fluence Q-switched and picosecond Nd:YAG lasers offer favorable profiles for pigmentary disorders and tattoo removal. Non-ablative fractional lasers can be used safely with conservative settings, whereas ablative modalities carry higher complication rates. Optimal outcomes require careful pre- and post-treatment considerations, including strict photoprotection and sequential, lower-energy treatments. Evidence gaps include a lack of large, prospective trials in darker skin types and standardized treatment parameters. Future research should prioritize inclusive study designs and pigment-specific protocols to improve safety, efficacy, and long-term outcomes in skin of color.

Vitamin B12 (cobalamin) deficiency remains a significant problem affecting both children and adults and is associated with a wide range of hematological manifestations that are largely preventable with timely diagnosis and treatment. Vitamin B12 deficiency can present with variable hematological, neuropsychiatric, and mucocutaneous changes. Hematological abnormalities are among the most common presentations. The classical peripheral blood smear shows macrocytosis with oval macrocytes, anisopoikilocytosis, and hypersegmented neutrophils. Anemia may be accompanied by leukopenia and thrombocytopenia due to ineffective hematopoiesis. Bone marrow examination typically reveals hypercellularity with erythroid hyperplasia and large megaloblasts exhibiting open chromatin and nuclear-cytoplasmic asynchrony as a result of defective DNA synthesis. Ineffective erythropoiesis leads to intramedullary destruction of hematopoietic precursors, resulting in elevated lactate dehydrogenase, indirect hyperbilirubinemia, and reduced haptoglobin, thereby mimicking hemolytic anemias. Abnormal red cells and megaloblasts that enter the circulation have a shortened lifespan, leading to megaloblastic anemia, with reticulocyte counts that are inappropriately low for the degree of anemia. In pediatric patients, manifestations may be severe, particularly in infants born to cobalamin-deficient mothers. Presentations include profound anemia, pancytopenia, failure to thrive, recurrent infections, and bleeding manifestations due to thrombocytopenia, often misdiagnosed as aplastic anemia or myelodysplasias. Pigmentary changes in the form of hyperpigmentation of knuckles, oral mucosa and rarely Addisonian pigmentation have been described. In older children, isolated anemia or bicytopenia with subtle macrocytosis may delay diagnosis. Severe presentations, seen in approximately 10% of cases, include pancytopenia, hemolytic anemia, and pseudothrombotic microangiopathy, which may mimic hematological malignancies or thrombotic microangiopathies. Early recognition is crucial, as vitamin B12 replacement leads to rapid and often complete hematological recovery.

Hyperpigmentation is a multifaceted process that involves the overproduction and uneven distribution of melanin. The number of patients with skin hyperpigmentation is on the rise, representing the most common complaint in dermatology clinics. Treatment focuses mainly on melanocyte reduction and stopping melanosome production due to their expected degradative effects. Kojic acid (KA), a widely known natural depigmenting agent of fungal origin, acts by inhibiting the action of tyrosinase, the enzyme that catalyzes melanin production. Although it has been used for many years in skin-lightening preparations, kojic acid suffers from many problems that reduce its efficacy, including poor chemical stability, hydrophilicity, and adverse effects. Many modern systems like polymeric, lipidic, and inorganic nanocarriers have been used to provide controlled release, improve the delivery of kojic acid to the target site of action, and provide protection during storage. Consequently, the aim of this narrative review is to present the current literature reports concerning the biological activity of kojic acid, with particular emphasis on recent advances in nanotechnology-based delivery systems, including lipidic, vesicular, polymeric, inorganic, and other emerging nanocarriers developed for pharmaceutical and cosmetic applications. This review also introduces prospective, next-generation delivery strategies that remain unaddressed in the current literature, which may optimize the therapeutic efficacy of kojic acid. It also reports the main challenges that face the use of nanoparticles for kojic acid delivery, namely, the lack of clinical validation, limited safety data, and large-scale production reproducibility, as well as regulatory constraints, thereby identifying key research gaps and future priorities that necessitate the prioritization of clinical evaluation of kojic acid delivery systems.

Background/Objectives: Dysregulated melanogenesis underpins numerous hyperpigmentation disorders. Gancidin W, a naturally occurring diketopiperazine with diverse biological activities, has attracted interest as a potential bioactive compound; however, its role in melanogenesis remains largely unexplored. This study aimed to evaluate the anti-melanogenic potential of Gancidin W through an integrated experimental and computational approach. Methods: Network pharmacology analysis was performed to investigate the potential molecular mechanisms of Gancidin W against hyperpigmentation. The cellular effects of Gancidin W were evaluated in α-MSH-stimulated B16F10 melanoma cells by assessing intracellular tyrosinase activity, melanin content, and cytotoxicity. Furthermore, density functional theory (DFT) calculations, molecular dynamics (MD) simulations, MM/GBSA binding free-energy analysis, and relative binding free-energy (RBFE) calculations were conducted to investigate the molecular interactions of Gancidin W and its structurally related analogue Maculosin with human tyrosinase-related protein 1 (hTYRP1). Results: Network pharmacology analysis predicted potential targets and signaling pathways involved in melanogenesis regulation. Gancidin W reduced intracellular tyrosinase activity by 34.54% and melanin content by 25.09% without cytotoxic effects. Multiscale computational analyses demonstrated stable interactions of Gancidin W within the hTYRP1 active site and favorable binding energetics (ΔGbind = -28.77 ± 0.75 kcal/mol). Compared with Maculosin, Gancidin W exhibited a more favorable binding profile, as supported by MM/GBSA and RBFE analyses, consistent with the inhibitory effects observed in the cellular assays. Conclusions: Gancidin W exhibits anti-melanogenic potential, and multiscale computational analyses provide molecular insights into its interaction with hTYRP1. These findings support further investigation of Gancidin W as a potential natural depigmenting agent for hyperpigmentation-related disorders.

Exogenous ochronosis is an acquired dyschromia, most often iatrogenic or cosmetic, resulting from the prolonged use of hydroquinone-containing skin-lightening topicals. Although rare in metropolitan France, it is still observed owing to the persistence of voluntary skin-lightening practices. We report the case of a 57-year-old woman of Central African origin, Fitzpatrick skin type V, with a several-year history of periorbital, temporal and upper-lip hyperpigmentation. The initial reading of the skin biopsy was interpreted as a non-specific histiocytic reaction to exogenous material. Expert review disclosed numerous yellow-brown, round, sickle- or banana-shaped ochronotic bodies deposited in the dermal connective tissue between collagen bundles, without birefringence and with no atypical melanocytic proliferation, establishing the diagnosis of exogenous ochronosis. A repeat history revealed the prolonged use of skin-lightening creams of unknown composition. This case highlights how the diagnosis may be overlooked when the relevant history is not available, and the value of clinicopathological correlation.

Central venous occlusion (CVO) is a common and serious complication in patients undergoing maintenance hemodialysis (MHD). A 62-year-old male on maintenance hemodialysis for 20 years was admitted with right upper limb swelling that had persisted for 2 years and had markedly worsened over the preceding 2 months. Physical examination revealed pronounced swelling of the right upper limb, accompanied by localized skin hyperpigmentation. Computed tomography angiography (CTA) and digital subtraction angiography (DSA) of the right upper extremity demonstrated complete occlusion of the right subclavian and innominate veins, with an occlusion length of approximately 6.5 cm. The occluded segment was successfully crossed using the kissing-wire and wire tensioning techniques. Subsequently, sequential balloon dilation was performed, followed by implantation of a 10 mm × 100 mm covered stent (Bard, Fluency Plus). Postoperative angiography demonstrated complete recanalization of the occluded vessel, with marked improvement in arteriovenous fistula blood flow. At the 3-month follow-up, no restenosis was observed. This case demonstrates that the combined use of kissing-wire and wire tensioning techniques for hemodialysis-related central venous occlusion is feasible and provides a valuable technical option for the endovascular management of complex central venous occlusions.

Serpentine supravenous hyperpigmentation (SSH) is a rare cutaneous adverse reaction characterized by linear hyperpigmentation along superficial veins following intravenous drug administration, most commonly chemotherapy. We report a rare case of melphalan-induced SSH complicated by superficial venous thrombosis. A 54-year-old man treated for kappa light-chain multiple myeloma developed asymptomatic serpiginous hyperpigmented lesions along the superficial venous network one day after peripheral intravenous melphalan infusion prior to autologous stem cell transplantation. Ten days later, the lesions became painful, and Doppler ultrasound revealed thrombosis of the involved superficial veins. The patient was successfully treated with oral anticoagulation and local care. SSH is generally considered benign and self-limited; however, painful lesions should prompt evaluation for vascular complications such as thrombosis. This case expands the spectrum of chemotherapeutic agents associated with SSH and highlights the importance of early recognition of atypical presentations and complications.

Serpentine supravenous hyperpigmentation (SSH) is a rare dermatological complication of intravenous chemotherapy characterized by linear hyperpigmented streaks along superficial veins. Bullous SSH represents an exceptionally rare variant with only a few previously reported cases in the literature. We report the case of a 50-year-old woman with HER2-positive breast cancer who developed bullous SSH 5 days after her first cycle of TCHP (docetaxel, carboplatin, trastuzumab, pertuzumab) chemotherapy. The patient presented with linear erythematous streaks and small tense bullae along the infusion vein on her right forearm. Treatment with topical mometasone furoate 0.1% ointment resulted in complete resolution within 2 weeks. Preventive strategies described for SSH include use of contralateral arm venous access, thorough saline flushing after chemotherapy infusion, consideration of central venous access when feasible, and, in selected cases, modification of the chemotherapy regimen. In our patient, subsequent chemotherapy cycles were administered using contralateral arm venous access with thorough saline flushing (same flushing protocol as Cycle 1), without recurrence of SSH. The patient completed all six planned cycles and subsequently achieved pathologic complete response. This case is the first to demonstrate that conservative management of bullous SSH with topical mometasone furoate, combined with contralateral venous access and thorough saline flushing, enables successful rechallenge and uninterrupted continuation of planned oncological treatment with pathologic complete response as the outcome.