In recent years, dermatoscopy has emerged as a valuable adjunctive tool for the diagnosis of various cutaneous disorders. Initially developed for the evaluation of melanocytic lesions, this non-invasive technique has since demonstrated significant utility in the assessment of non-melanocytic hyperpigmented dermatoses. This review provides an up-to-date and practical overview of the dermatoscopic manifestations of common non-melanocytic hyperpigmented conditions, including melasma, nevus of Ota, freckles, lentigines, solar lentigines, seborrheic keratosis, porokeratosis, acquired dermal macular hyperpigmentation, lichen planus-like keratosis, pigmented actinic keratosis, pigmented Bowen's disease, basal cell carcinoma, and acanthosis nigricans. Many of these hyperpigmented disorders exhibit distinct and characteristic dermatoscopic features. Given the clinical diagnostic challenges posed by these conditions and their significant psychological impact on patients, dermatoscopy offers a complementary approach to enhance the accuracy of evaluation and differential diagnosis.

Familial partial lipodystrophy (FPLD) is a rare inherited disorder characterized by limb adipose tissue atrophy and metabolic abnormalities, including severe insulin resistance. However, diagnosis is often delayed because the characteristic physique can be difficult to recognize without a high index of suspicion. We present the case of a 19-year-old Japanese woman diagnosed with FPLD type 2 (FPLD2). She had a history of irregular menses and hirsutism since adolescence. The FPLD2 diagnosis was prompted by her concerns about axillary and inguinal pigmentation. Her mother's online search first suggested acanthosis nigricans (AN). After including "muscular limb" as an additional search term, they suspected lipodystrophy, prompting a consultation with an endocrinologist. Clinical examination revealed impaired glucose tolerance, severe insulin resistance, dyslipidemia, fatty liver, and polycystic ovary syndrome. Genetic testing identified a heterozygous LMNA p.R482Q variant, confirming the diagnosis. This case demonstrates that AN, a skin manifestation of insulin resistance, is an important diagnostic clue for FPLD. Although women with FPLD frequently present with menstrual irregularities and hirsutism in their late teens, their insulin levels are rarely measured before diabetes onset. Consequently, the underlying severe insulin resistance is frequently overlooked. Although reported cases of FPLD2 in Japan are limited, many cases may remain undiagnosed. Therefore, clinicians should examine the friction-prone areas in non-severely obese individuals with metabolic or menstrual irregularities. The absence of AN does not rule out insulin resistance. Therefore, even without AN, the presence of other features of insulin resistance warrant consideration of FPLD and careful evaluation for limb fat loss, facilitating early diagnosis.

Morbid obesity is a chronic condition characterized by metabolic disorders and low-grade chronic inflammation, both of which are closely linked to insulin resistance and adipokine dysregulation. In addition to its systemic effects, obesity also leads to structural and functional changes in the skin, supporting its role as an active metabolic and immunological organ. This study analyzed skin lesions occurring in individuals with morbid obesity and explored their potential relevance in the context of metabolic risk and treatment response rather than establishing clinically validated tools. The focus was on how excess adipose tissue affects the skin through metabolic, hormonal and mechanical mechanisms. Although this review focuses on morbid obesity, many of the included studies examine general obesity without separating its severity. Therefore, the findings may not fully reflect patients with BMI ≥ 40 kg/m[2] and should be interpreted with caution. Three main areas were considered: the pathophysiological mechanisms underlying obesity-related skin lesions, selected dermatological manifestations as potential markers associated with metabolic risk, and changes in these manifestations during pharmacological, surgical, and lifestyle interventions. Available studies show that acanthosis nigricans and multiple acrochordons are consistently associated with insulin resistance, metabolic syndrome, and metabolic dysfunction-associated steatotic liver disease. An increase in BMI is also associated with impairment of the epidermal barrier, changes in the composition of skin lipids, and modifications of the skin microbiome, while biomechanical factors promote the development of chronic inflammation in the intertriginous areas. It has been shown that normalization of metabolic parameters achieved through GLP-1-based pharmacotherapy, bariatric surgery, or lifestyle changes can improve some skin manifestations, especially acanthosis nigricans. However, it should be emphasized that most available data are based on cross-sectional or observational studies, and validated composite dermatological indices are still unavailable. Skin changes in patients with morbid obesity often reflect underlying metabolic and hormonal disturbances. They may have potential as additional, non-invasive clinical clues, but they should not be treated as independent tools for risk assessment or treatment monitoring. At present, most evidence shows associations only, and it is unclear whether these findings add meaningful predictive value beyond standard metabolic markers. More prospective studies are needed to confirm their clinical usefulness and to define their role in assessing metabolic risk and monitoring treatment over time.

Facial melanoses (FMs) encompass a diverse group of disorders characterised by altered facial pigmentation, particularly prevalent in individuals with darker skin types, such as the Indian population. While common causes like melasma, post-inflammatory hyperpigmentation, and lichen planus pigmentosus are well documented in the literature, this review emphasises the lesser-known and uncommon causes of FM. These include facial acanthosis nigricans, maturational hyperpigmentation, frictional facial melanosis, and seborrheic melanosis, which are frequently observed in Indian populations but remain underrecognised and understudied. The aetiology of FM is multifactorial, involving genetic predisposition, racial factors, ultraviolet radiation, and exposure to photosensitising chemicals and allergens. Uncommon causes often present unique diagnostic challenges and are frequently misdiagnosed due to their overlapping clinical features. Diagnosis relies on clinical evaluation, supported by Wood's lamp examination, dermoscopy, and, in some cases, skin biopsy. FM can be classified into brown, blue, or mixed hypermelanosis based on the location and nature of melanin deposition. Management of these uncommon conditions is complex and requires a nuanced approach. Photoprotection remains a cornerstone of therapy, alongside topical depigmenting agents, chemical peels, and laser or light-based interventions. However, the risk of post-inflammatory hyperpigmentation in richly pigmented skin necessitates cautious and individualised treatment strategies. The lack of standardised guidelines for these uncommon causes further complicates management, underscoring the need for tailored therapeutic approaches. This review highlights the clinical significance of recognising and addressing uncommon causes of FM, which significantly impact patients' quality of life and psychosocial well-being. Enhanced awareness, further research, and the development of evidence-based treatment protocols are essential to improve outcomes for patients with these understudied conditions. By focussing on these uncommon causes, this review aims to fill a critical gap in the literature and provide a comprehensive resource for clinicians managing facial melanoses in skin of colour. Such comprehensive articles are lacking in literature.

This observational study was designed to establish and validate a stigma prediction model for patients with polycystic ovary syndrome (PCOS). The stigma risk scoring table for overweight and obese patients with PCOS has good predictive ability. When an overweight or obese patient with PCOS presents, the prediction model allows clinic staff to rapidly grade hirsutism, acne, and acanthosis, determine fertility desire, and quantify anxiety. Low-risk patients then receive standard care, whereas high-risk patients receive precision interventions. Unlike the traditional approach, this clinical prediction model incorporates not only laboratory values but also body-image concerns and psychological well-being, providing more comprehensive management for women with PCOS. To preliminarily explore the associations among stigma, PCOS signs, anxiety, and depression. A total of 124 overweight and obese patients with PCOS were selected using convenience sampling. The patients in the order of clinic visit time were divided into a modeling set and a validation set at a ratio of 3:1. Univariate analysis was first performed, normally distributed continuous variables were compared using t-tests, non-normally distributed continuous variables with nonparametric rank-sum tests, and categorical variables with χ2 tests. Independent risk factors for stigma were identified using multivariable logistic regression, and a nomogram was constructed. The model's discrimination and calibration were evaluated with the receiver operating characteristic curve and calibration curve. Internal validation was subsequently conducted on the validation data set to assess model performance comprehensively. Hirsutism (odds ratio [OR]=0.075, 95%Cl: 0.015-0.368) , acne (OR=0.210, 95%Cl: 0.050-0.878) , acanthosis nigricans (OR=0.184, 95%Cl: 0.044-0.073) , fertility requirements (OR=0.212, 95%Cl: 0.051-0.890) , and anxiety (OR=1.217, 95%Cl: 1.074-1.378) were independent influencing factors for stigma in these patients (P < .05). The constructed prediction model also demonstrated good predictive ability, with area under the curve values of 0.941 and 0.803 for the modeling and validation sets, respectively. Internal validation using 1000 bootstrap resamples revealed a mean area under the receiver operating characteristic curve area under the curve of 0.941.

PURPOSE: Many women suffer from hyperandrogenic conditions during their lifespan. The most prevalent is polycystic ovary syndrome (PCOS), which is characterized by hormonal, metabolic, and reproductive derangements in women of reproductive age. Endometrial cancer of epithelial origin (EC) is among the most common malignancies affecting women’s reproductive systems. It has been suggested that androgens are involved in the development of endometrial hyperplasia and EC. Our narrative review aims to analyze the possible relationship between hyperandrogenic states in women and EC onset through risk assessment providing possible pathophysiological explanations. METHODS: A MEDLINE and PubMed search for the years 1990–2024 was performed using a combination of keywords. Scientific articles on EC in patients with PCOS, hyperandrogenism-insulin resistance-acanthosis nigricans (HAIR-AN), and non-classical congenital adrenal hyperplasia (NCAH) were analyzed. RESULTS: There is controversy regarding the relationship between the role of androgens associated with the EC. Despite the fact that most of the epidemiological research linked PCOS to the onset of EC, it has been proposed that various androgen types have varying impacts on the development of EC, both prooncogenic and antioncogenic. Furthermore, elevated androgen levels are not the sole cause of EC in hyperandrogenic states; EC may be associated with metabolic pathway dysfunction and microbiota alteration related to hyperandrogenism. CONCLUSION: The hyperandrogenic milieu may represent a risk factor for the development of EC. Thus, investigation into potential biomarkers for EC in PCOS women and women with other hyperandrogenic states as well as routine examination of these patients for endometrial hyperplasia and cancer are vital to effectively shape the future of EC screening and treatment.