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J Am Acad Dermatol 1989

Huang W, Wang H, Sun Q et al

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It is necessary for normal growth and development, and is an essential enzyme cofactor for several enzymes in the post-translational hydroxylation of collagen, biosynthesis of carnitine, conversion of the neurotransmitter dopamine to norepinephrine, peptide amidation, and in tyrosine metabolism

Contributing factors can include ultraviolet (UV) light exposure from the sun or tanning beds, genetics, and certain skin types

In a small proportion of cases, the melanin may be prominent enough to be visualized as foci of dark-brown or black discoloration ( Fig