Cutaneous hyperpigmentation can be present in 70% of patients due to two different mechanisms:
(1) hemosiderin deposition => diffuse, slate-gray darkening of skin
(2) increased production of melanin in the epidermis (this is what causes bronzing hyperpigmentation!!!)
If you get asked = the visible pigmentation (aka bronzing) manifests due to increased melanin in the basal layer of the epidermis. [1]
References
1. Pietrangelo A. Hereditary hemochromatosis—a new look at an old disease. N Engl J Med. 2004;350(23):2383–2397. [PubMed]
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