Dermoscopic patterns in pigmented skin: Reflections and challenges

Dermoscopy has become an invaluable non-invasive tool in general dermatology, extending beyond melanocytic and keratinocytic tumors to inflammatory, infectious, and pigmentary dermatoses. However, most structured evidence originates from fair-skinned populations, with studies in skin of color or pigmented skin being relatively limited. This review synthesizes current knowledge on dermoscopic patterns across a wide range of dermatoses in pigmented skin, with particular emphasis on distinctive features and diagnostic challenges. Pigmentary alterations are the most consistent dermoscopic findings in pigmented skin, while vascular patterns and erythema are often less prominent compared to lighter phototypes. Chronic lesions may display additional pigmentary clues, including bluish-brown globules, blotches, or clods, reflecting pigmentary incontinence. Certain hallmark features such as Wickham striae in lichen planus, keratin rims in porokeratosis, or collarette scaling in pityriasis rosea remain reproducible across skin tones, but differences in contrast and background pigmentation may obscure subtle vascular or erythematous changes. Despite recent growth in the literature, most studies are small, descriptive, and lack standardized terminology, limiting diagnostic accuracy and cross-study comparability. Furthermore, the underrepresentation of diverse skin tones, especially darker phototypes, restricts generalizability. Addressing these gaps through systematic, inclusive research and uniform clinicodermoscopic and histopathological correlation is crucial to enhance the reliability of dermoscopy across all skin types and to reduce disparities in dermatologic diagnosis and care.