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On examination, well-demarcated areas of pigmentation localized to knuckles of both hands were noticed (Figure 1)

Consult a doctor if you experience: Persistent fatigue that doesnt improve with rest Breathlessness during routine activities Frequent dizziness or fainting Heavy menstrual bleeding (more than 7 days or soaking pads rapidly) Blood test results showing hemoglobin below 10 g/dL Symptoms that are not improving despite two to three months of dietary changes Chest pain, severe weakness, or sudden fainting require emergency medical attention immediately

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