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In Fitzpatrick III through V skin, common in Hispanic, Caribbean, and Mediterranean populations, PIE often presents differently than the classic pink or red appearance: Marks may look violet, dusky pink, or dark plum rather than bright red The blanch test still works (vascular marks blanch regardless of skin tone), but the color shift may be subtle and harder to see PIE frequently coexists with PIH in the same lesion, creating a layered red and brown appearance Both pathologies require concurrent treatment, not sequential When we evaluate PIE in patients with deeper skin tones at our Doral clinic, we adjust the protocol in three ways

The dosage and frequency of injections will depend on the individuals B12 levels and specific health needs

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Sixteen patients were contacted to review their knee pain symptom improvements 6 months to 1 year after receiving the injections