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Hyperpigmentation is often more pronounced on the limbs, primarily on the dorsum of the hands and feet, in flexural areas, and occasionally on the nails, tongue, and oral mucous membranes.3 Since hyperpigmentation is a nonspecific symptom, a broad range of differential diagnoses should be considered in such cases: diabetes mellitus, Addison disease, Cushing syndrome, post-inflammatory lesions, amyloidosis, melanosis of the skin, heavy metal deposition, thyroid disease, tumors, drug reactions, and porphyria cutanea tarda, among others.4 The pathophysiology of hyperpigmentation is still a matter of debate