![]() It is most visible on scars, skin folds, lips, mucous membranes, and pressure points such as the elbows, knees, knuckles, and toes.ĭarkening of the skin is caused by increased corticotrophin production by the pituitary gland in an attempt to stimulate the adrenal glands, which also stimulates melanin production. It is one of the earliest signs of AD and usually starts in the buccal mucosa and gums and then affects the skin. The most characteristic finding on physical examination is hyperpigmentation (Figure 1), which occurs in almost all patients with AD (except in patients with acute onset of primary AI due to short duration of disease) and is never present in secondary or tertiary AI. ![]() Characteristic findings on physical examination
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