This comprehensive educational resource addresses a critical gap in dermatology training: the underrepresentation of xeroderma pigmentosum (XP) clinical presentations on darker skin types (Fitzpatrick phototypes IV–V). Despite higher disease prevalence in South Asian, Middle Eastern, and North African populations due to consanguinity patterns, most dermatology literature depicts XP on Caucasian skin, creating diagnostic challenges for clinicians in high-burden regions. This document provides:- Evidence-based clinical review of XP molecular genetics, pathogenesis, and phenotypic heterogeneity- High-quality photographic documentation of XP manifestations on Fitzpatrick type IV–V skin from an Indian pediatric patient- Detailed morphological descriptions adapted for darker skin examination- Systematic differential diagnosis algorithm for lentiginosis syndromes with cognitive impairment- Master comparison table of 20 differential diagnoses with bedside exclusion criteria- Practical management protocols for resource-limited settings- Teaching points specifically tailored for South Asian clinicians TARGET AUDIENCE: Pediatricians, dermatologists, geneticists, medical students, and healthcare professionals in South Asia, sub-Saharan Africa, Middle East, and North Africa. EDUCATIONAL USE: This resource is designed for clinical teaching, case-based learning, diagnostic reference, and continuing medical education. It may be freely adapted for educational purposes with attribution. CLINICAL CONTEXT: Case from tertiary care center in Rajasthan, India. All clinical content is derived from peer-reviewed literature and UpToDate (referenced throughout). Institutional consent obtained for educational use of clinical photographs. KEYWORDS: Xeroderma pigmentosum, darker skin, Fitzpatrick IV-V, South Asian dermatology, pediatric genodermatoses, nucleotide excision repair, clinical teaching, lentiginosis differential diagnosis, consanguinity, resource-limited settings.