Maturational Hyperpigmentation: Cutaneous Marker of Metabolic Syndrome

Abstract

A 62-year-old Indian man with a strong family history of metabolic syndrome (MeTS) presented with asymptomatic, gran-ular-surfaced, dark brown pigmentation on the cheeks (Figure 1, A and B). Nuchal/axillary acanthosis nigricans (AN) were conspicuously absent. Dermoscopy showed exaggerated light brown pseudoreticular network and scattered brown globules and structureless areas. At higher magnification (×150), oval dark brown annular "ring"-like structures centered around hair follicles were observed (Figure 1C). The dermoscopic image was conspicuously devoid of sulci/cristae (which are considered typical of AN). Examination and biochemical evaluation revealed blood pressure = 160/102 mm Hg, waist circumference = 92 cm, fasting blood glucose = 126 mg/dL, and fasting serum triglycerides = 438 mg/dL, confirming central obesity with MeTS. Histopathology revealed hypermel-anized epidermis and dermis, and basal melanocytosis (Figure 1D). Clinicodermoscopicopathological correlation diagnosis was maturational hyperpigmentation (MH) with MeTS. Teaching Point Although facial AN and MH may actually represent evolutionary standpoints on the morphological spectrum of cuta-neous markers of MeTS (CMM) [1], labeling them as synonymous [2] without dermoscopy/supportive evidence seems inappropriate at present. Maturational hyperpigmentation is a newly described facial melanosis. It is a CMM akin to facial AN with which it does share some morphological features as well; however, specific features such as relatively softer surface with conspicuous but finer granularity and indistinct margins on gross morphology, and distinctive dermoscopy and histopathology [1], warrant identification of MH as a separate nosological entity. Thus, every physician's awareness of this relatively less evident and lesser-known asymptomatic entity is paramount to facilitate prompt workup for MeTS. Citation: Sonthalia S, Agrawal M, Sharma P, Pandey A. Maturational hyperpigmentation: cutaneous marker of metabolic syndrome.