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In most patients, it would be due to a condition called post-inflammatory hyperpigmentation due to friction from clothing or kneeling on the area for many years

Consolidation phase

In patients who have severe thrombocytopenia or any coagulation disorder that would contraindicate intramuscular injections, hepatitis B immune globulin (human) should be given only if the expected benefits outweigh the risks

Zhang L, Qin Z, Sun H, Chen X, Dong J, Shen S, et al

The most important ROS include superoxide anion, hydroxyl radical, and hydrogen peroxide (H 2 O 2 ), while the principal antioxidant enzyme systems are SOD, glutathione peroxidase, and catalase