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Hyperpigmentation is exclusively found in the papillae and usually has onset in childhood and is not progressive.2 The differential diagnosis includes Addison disease, Peutz-Jeghers syndrome, black hairy tongue, melanotic macule and melanocytic naevus.1 Paediatricians and paediatric dermatologists must be aware of this condition, as it can be diagnosed based on the clinical picture, avoiding the use of invasive tests.

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For context, the fat-mass reductions reported in Billon 2024 roughly 25-30% in diet-induced obese mice over 28 days without exercise are large for a preclinical metabolic agent and explain why the "exercise mimetic" label stuck