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Dermatosis papulosa nigra (DPN) is a variant of seborrheic keratosis that typically presents as hyperpigmented pedunculated papules on the face, trunk, and/or back in those with skin of color. Although benign, the lesions can cause significant discomfort and distress. Management options are limited and often unaffordable, as treatment is elective in most cases. This study was undertaken to provide an updated summary of safe and efficacious treatments for DPN. Five databases were searched to identify full‐text publications reporting on treatments and outcomes in adults with DPN. Seventeen publications met inclusion criteria and were included: six cohort studies, one randomized controlled trial, five case report studies, one case series, and four pilot studies. Treatment options included simple excision, curettage, electrodesiccation, cryotherapy, topicals, and laser therapies. These modalities varied in their documented outcomes and associated potential adverse effect profiles. Postinflammatory hyperpigmentation is a common adverse effect that often leads to patient dissatisfaction. It can be mitigated with topical treatments aimed at reducing local inflammation. Study limitations included small sample size in individual studies, lack of consistent reporting of Fitzpatrick skin type, and lack of comparison to the standard treatment of electrodesiccation or curettage. Ultimately, treatment should consider the patient's Fitzpatrick type, treatment area, associated costs, and potential adverse effects. [ABSTRACT FROM AUTHOR]

Background: Solar lentigo, a common epidermal hyperpigmented lesion found in sun‐exposed areas, results from the proliferation of melanocytes and the accumulation of melanin. Although various treatments for solar lentigo have been explored, they often lead to complications, including prolonged erythema and post‐inflammatory hyperpigmentation (PIH), posing significant concerns. Objectives and methods: This study evaluated the safety and efficacy of the Vasculature Salvage Laser Surgery (VSLS) system. We treated six Korean patients, each with solar lentigo, in a single session using the 532‐nm nanosecond neodymium‐doped yttrium aluminum garnet (Nd:YAG) VSLS system, with follow‐up periods ranging from 3 to 10 weeks. Results: The treatment led to the complete removal of pigmented lesions in all patients without resulting in PIH, even in cases where previous laser treatments had failed. The only side effect observed was mild erythema, which resolved over the long term in most instances. Conclusions: The VSLS system emerges as a safe and effective treatment for pigmented lesions, including refractory solar lentigines. Nonetheless, additional studies are required to verify its long‐term efficacy. [ABSTRACT FROM AUTHOR]

Objective: This study aimed to investigate the effectiveness of prophylactic photobiomodulation (PBM) in reducing postinflammatory hyperpigmentation (PIH) induced by carbon dioxide (CO2) laser resurfacing in a patient with periorbital syringomas. Background: PIH is a common condition characterized by abnormal skin pigmentation after an inflammatory process occurring in up to 20-30% of patients undergoing CO2 laser resurfacing. Methods: The patient was treated with PBM using a pulsed home-use device at 630 nm before and after CO2 laser treatment. The patient was asked to treat the right periorbital area before and after the CO2 laser treatment, which was continued once a day for 2 consecutive weeks. Results: At 12 weeks, PIH was significantly reduced on the treated side compared with the contralateral untreated side (leading to persistent erythema at 6 months). Conclusions: This is the first report of prophylactic treatment of CO2 laser-induced dyschromia using PBM. [ABSTRACT FROM AUTHOR]

Background Postinflammatory hyperpigmentation (PIH) is not harmful but can affect appearance and quality of life. It occurs due to increased melanin production after cutaneous injury or inflammation. Axillary hyperpigmentation, one of the commonly acquired hypermelanosis, raises concern, and treatment regarding this condition is still evolving. Sweet orange contains several components that can improve pigmentation through tyrosinase inhibition and antioxidant mechanisms. The objective was to determine the efficacy of sweet orange peel extract cream on axillary hyperpigmentation. Methods This quasi-experimental study is a pretest-posttest design on 32 subjects with axillary hyperpigmentation. Diagnosis is established through history taking and clinical evaluation. Evaluation of melanin index using Mexameter® MX18 was carried out at weeks 0, 2, 4, 6, and 8. Clinical evaluation improvement made using Physician Global Assessment. Side effects and satisfaction during the study are also recorded. The data is processed using the Friedman test, with p Results There was a statistically significant decrease in melanin index on axillary hyperpigmentation (p Conclusions The use of 0.1% sweet orange peel extract cream can improve axillary postinflammatory hyperpigmentation.

Background: Dyschromias are the second most commonly diagnosed dermatological entity in patients with skin of color (SOC). People with SOC develop postinflammatory hyperpigmentation (PIH) with a higher frequency and greater severity attributed to the presence of reactive melanocytes. This can have severe repercussions on selfesteem and social/emotional functioning. While there are studies on the impact of post-acne PIH on quality of life (QOL), the assessment of impact of PIH on QOL as a heterogenous group of dermatoses has not been studied previously. Objectives: The aim of this study was to assess the impact of PIH on QOL in patients with SOC using Skindex-16. Materials and Methods: This was a cross-sectional study conducted from October 2019 to September 2021, involving 60 patients with SOC having biopsy-proven PIH. All patients underwent thorough clinical workup, followed by the administration of the Skindex-16 questionnaire. Data were tabulated and analyzed. Results: The mean age was 32.53±11.73 years: 35 (58%) patients were male, and 25 (42%) were females. Most patients presented with PIH secondary to papulosquamous disorders (n=23; 38.34%), followed by acne/acneiform eruptions (n=11; 18.33%). The mean scores for symptoms, emotions, functioning, and total scores were 0.37±0.51, 2.30±1.13, 2.26 ±1.40, and 1.64±0.85, respectively. PIH lesions with simultaneous evolution were associated with higher symptoms subscale scores. A previous tendency of PIH, involvement of exposed sites, higher intensity of PIH, epidermal PIH, and lesions accentuating on Wood's lamp had higher, statistically significant impact on emotions, functioning, and total scores. Conclusion: PIH had significant impact on Quality of Life in patients of Skin-of-Color. Our study was limited by the sample size, and larger, multicentric, population-based studies are recommended. [ABSTRACT FROM AUTHOR]

Background: Dyschromias are the second most commonly diagnosed dermatological entity in patients with skin of color (SOC). People with SOC develop postinflammatory hyperpigmentation (PIH) with a higher frequency and greater severity attributed to the presence of reactive melanocytes. This can have severe repercussions on self-esteem and social/emotional functioning. While there are studies on the impact of post-acne PIH on quality of life (QOL), the assessment of impact of PIH on QOL as a heterogenous group of dermatoses has not been studied previously. Objectives: The aim of this study was to assess the impact of PIH on QOL in patients with SOC using Skindex-16. Materials and Methods: This was a cross-sectional study conducted from October 2019 to September 2021, involving 60 patients with SOC having biopsy-proven PIH. All patients underwent thorough clinical workup, followed by the administration of the Skindex-16 questionnaire. Data were tabulated and analyzed. Results: The mean age was 32.53±11.73 years: 35 (58%) patients were male, and 25 (42%) were females. Most patients presented with PIH secondary to papulosquamous disorders (n=23; 38.34%), followed by acne/acneiform eruptions (n=11; 18.33%). The mean scores for symptoms, emotions, functioning, and total scores were 0.37±0.51, 2.30±1.13, 2.26 ±1.40, and 1.64±0.85, respectively. PIH lesions with simultaneous evolution were associated with higher symptoms subscale scores. A previous tendency of PIH, involvement of exposed sites, higher intensity of PIH, epidermal PIH, and lesions accentuating on Wood's lamp had higher, statistically significant impact on emotions, functioning, and total scores. Conclusion: PIH had significant impact on Quality of Life in patients of Skin-of-Color. Our study was limited by the sample size, and larger, multicentric, population-based studies are recommended. [ABSTRACT FROM AUTHOR]

The CO2 laser has been widely utilized in dermatology; its expanding clinical applications include the management of neoplastic lesions, benign growths, cosmetic conditions, and reactive disorders. The laser's popularity is mainly due to the high precision and short recovery time this technology provides. However, postinflammatory hyperpigmentation (PIH) has been one of the challenging adverse effects of the CO2 laser. Therefore, several modalities have been studied for the prevention of PIH following CO2 laser treatment. This review aims to analyze the incidence of PIH after CO2 laser therapy, identify its risk factors, and assess the efficacy of the examined treatment modalities in preventing PIH. Pubmed and Embase databases were searched for this study, and relative clinical trials were included in the review. Descriptive findings -- including age, gender, skin type, types of intervention, and incidence of PIH ---- were reported. When appropriate, the incidence of PIH was compared across each possible individual factor, such as skin type, gender, and type of intervention. A total of 211 articles were identified, and 14 relevant articles were included in this review. Seventy percent of the subjects were females (n=219), and 30% were males (n=94), with a mean age of 30 years (SD=7.8). The most common skin types were type IV (59%) followed by type III (25%). In total, eight studies investigated the prevention of PIH. The incidence of PIH after CO2 laser significantly varies between studies and differs based on the type of intervention. The studies indicate that the use of Clobetasol propionate 0.05% and fusidic acid cream appeared to effectively reduce PIH, recording an incidence rate of 39% and 53.3%, respectively. The Fitzpatrick-skinphenotype did not appear to influence the risk of PIH. There is a lack of high-powered clinical studies analyzing the incidence of PIH after CO2 laser treatment and the associated risk factors. PIH occurrence may be related to inflammation resulting from thermal damage by the CO2 laser. Consequently, the use of postoperative topical medications with anti-inflammatory properties might reduce its incidence. The use of ultra-potent topical corticosteroids and topical fusidic acid appeared to reduce PIH, possibly reducing postoperative inflammation effectively. Similarly, platelet-containing plasma may be beneficial in reducing CO2 side effects, including PIH. However, more studies are needed to further establish the influence of skin type on PIH and investigate modalities to reduce PIH occurrence after CO2 laser use. [ABSTRACT FROM AUTHOR]

Visible light has been used therapeutically in dermatology for years for a variety of cosmetic and medical indications, including skin rejuvenation and the treatment of inflammatory and neoplastic conditions, among others. Until recently, visible light was thought to be relatively inert compared to its spectral neighbors, ultraviolet and infrared radiation. However, recent literature has described the ability of visible light to cause erythema in light skin and pigmentary changes in individuals with darker skin types. Concern surrounding its potentially damaging cutaneous effects has been raised in both the medical community and social media outlets. In this article, we provide an evidenced-based review describing what is currently known about visible light, focusing on its role in dermatologic diseases including disorders of hyperpigmentation such as melasma and postinflammatory hyperpigmentation. [ABSTRACT FROM AUTHOR]

Background: Extracellular matrix (ECM) components promote the development of skin wounds by providing biological scaffolds and regenerative microenvironments. Aims: To evaluate the beneficial effects of human dermal fibroblast‐derived ECM after fractional carbon dioxide laser resurfacing in Asians. Patients/Methods: In this double‐blind, randomized, vehicle‐controlled, split‐face study, 15 participants with features of facial skin aging were treated with a single session of fractional carbon dioxide laser, followed by the application of either ECM (ECM group) or placebo (control group). In vivo skin parameters were measured at baseline and after 4 and 12 weeks of treatment using the Antera 3D®, Cutometer® MPA580, Dermascan®, and Tewameter®. Results: A total of 14 participants (mean age 45.1 ± 9.7 years) completed the study. The change in melanin level was significantly lower in the ECM group than in the control group at week 12 (p < 0.05). Transient increase in erythema level was observed at week 4 in the control group, and the change in the erythema level was greater in the control group than in the ECM group (p = 0.014). Though the ECM group showed improvements in the dermal density, texture, transepidermal water loss, marionette lines (volume, maximum depth, and average depth), and nasolabial folds (volume, maximum depth, and length), no significant differences were found between the two groups. Treatment‐related adverse events were not reported. Conclusions: We suggest that human dermal fibroblast‐derived ECM may be used as adjunctive therapy after fractional carbon dioxide resurfacing to prevent postinflammatory hyperpigmentation in Asians. [ABSTRACT FROM AUTHOR]

Acne vulgaris can be associated with hyperpigmentation, particularly in individuals with skin of color. This acne-induced macular hyperpigmentation (AMH), also called postinflammatory hyperpigmentation, is often long lasting and negatively impacts quality of life. Large-scale, randomized, controlled clinical trials with regard to the treatment of acne and AMH are lacking. For this reason, evidence-based treatment recommendations cannot be made. However, AMH is a common condition, and it is important for clinicians to have guidance on management strategies. The authors, a group of 10 board-certified dermatologists, conducted a modified Delphi consensus process to reach a consensus on first-line therapy for AMH and determine whether therapeutic choices change in different patient subgroups. We reached a consensus that most patients with acne and AMH should receive early and efficacious acne treatment with a topical retinoid and benzoyl peroxide. Therapies aimed at addressing AMH—including hydroquinone, azelaic acid, chemical peel, or antioxidants—may also be considered for enhancing the effect of the treatment regimen on acne and pigmentation. Chemical peels may be used as adjunctive or second-line therapy. This article details the results of the Delphi process, reviews relevant literature for providing recommendations for AMH, and discusses appropriate treatment options. [ABSTRACT FROM AUTHOR]

BACKGROUND: Changes in skin pigmentation patterns related to the fluctuation of estrogen receptors and progesterone receptors during menstruation, also known as catamenial hyperpigmentation, have been reported in several studies. OBJECTIVE: We sought to summarize the literature on catamenial skin hyperpigmentation and menses-induced exacerbations of skin pigmentation disorders. METHODS: We searched PubMed/MEDLINE and the Cochrane Skin database with the search terms menses and pigment, estrogen and pigment, progesterone and pigment, and hyperpigmentation and menses, then assessed the relevant literature on skin diseases related to nonpathological menstruation. RESULTS: The most commonly reported primary catamenial hyperpigmentation disorders are postinflammatory hyperpigmentation (PIH) after laser therapy and ultraviolet sensitivity (UV). The most reported chronic skin pigmentation exacerbated by menses is melasma. The literature detailing catamenial hyperpigmentation is limited to cross-sectional studies, experimental studies, surveys, review articles, case reports, and small trials, leading to a lower level of evidence. CONCLUSION: Our review of the literature revealed that the most common catamenial hyperpigmentation is melasma. We also found a reported higher risk of PIH after laser therapies and UV sensitivity. Estrogen and progesterone are two of the major factors responsible for catamenial hyperpigmentation of the skin. Generally, the changes happen in the luteal phase of the menstrual cycle when the serum levels of sex hormones are at their peak. Although the exact balance of influence is controversial, most recent studies indicate that estrogen has a more prominent role than progesterone in inducing hyperpigmentation.

Background: There is a lack of evidence on the therapeutic efficacy of topical tranexamic acid (TA) for the treatment of acne-related postinflammatory hyperpigmentation (PIH). The current study aimed to assess the efficacy of twice-daily administration of 20% azelaic acid (AZA) cream versus 5% TA solution for the treatment of PIH in patients with acne vulgaris. Materials and Methods: Patients in the present single-blinded randomized clinical trial were randomized into AZA or TA groups for 12 weeks. The rate of healing was assessed by scoring recorded photographs based on postacne hyperpigmentation index (PAHI) at baseline, 4th, 8th, and 12th weeks. The frequency of side effects was examined and recorded at each study time point. Results: Thirty volunteers in each treatment group completed the intervention. PAHI score in both AZA and TA groups improved during the study course (Ptime < 0.001, for both groups). However, mean PAHI scores were comparable in the two groups (Pgroup = 0.05). No significant interaction was also found between time and treatments in terms of PAHI score (Ptime - group = 0.66). The frequency of treatment-related side effects was significantly higher in the AZA group compared to the TA group at week 4 of treatment (P < 0.05). However, no significant difference was observed in the frequency of reported side effects at weeks 8 and 12 of the treatment (P > 0.05). Conclusion: Topical administration of 20% AZA cream and 5% TA solution was comparably efficient in the treatment of acne-related PIH with a significantly better safety profile of TA in the 1st month of the treatment. [ABSTRACT FROM AUTHOR]

Background: The therapeutic efficacy of laser treatments for acquired bilateral nevus of Ota‐like macules (ABNOM) varies among studies, and few studies have evaluated the factors affecting therapeutic effects. Aims: To evaluate the efficacy and safety of 1064‐nm Q‐switched Nd:YAG laser (QSNYL) therapy for ABNOM and to identify the factors influencing the outcome. Methods: A total of 110 patients with ABNOM were retrospectively evaluated and received two‐to‐nine treatment sessions. The effects of different factors on the therapeutic effect were analyzed on the basis of the number of treatments, age at first treatment, skin type, lesion color, affected area, number of lesion sites, and presence of concomitant melasma. Results: The curative effect was positively correlated with the treatment time and negatively correlated with the increasing age at first treatment (p < 0.05). The curative effect was better in patients with skin type III than those with type IV (p < 0.05) and in patients with a lesion area of less than 10 cm2 than those with a larger affected area (p < 0.05). Additionally, the treatment effect was poorer in patients with concomitant melasma (p < 0.05). The treatment effect was not significantly correlated with the lesion color or number of affected sites (p > 0.05). Eleven patients (10%) developed postinflammatory hyperpigmentation (PIH). Conclusions: Early and repeated QSNYL therapy achieved satisfactory results for ABNOM. The risk of PIH after laser treatment is highest among patients with older age, darker lesion color, and darker skin color. For patients with ABNOM with concurrent melasma, low‐energy laser therapy is recommended to reduce the risk of melasma aggravation. [ABSTRACT FROM AUTHOR]

Key challenges in the management of pigmentary disorders such as melasma and postinflammatory hyperpigmentation are their resistance to treatment, tendency to recur after treatment, and the risk of exacerbating hyperpigmentation with many treatment modalities. The second article in this 2-part continuing medical education series on pigmentary disorders focuses on the evidence behind medical and procedural treatments of dyschromias, including photoprotection, topical lightening agents, oral agents, chemical peels, and laser therapy. [ABSTRACT FROM AUTHOR]

Disorders of hyperpigmentation are common and, depending on the extent and location of involvement, can affect the quality of life and pose a significant psychologic burden for patients. Given the similarities in presentation of the various causes of hyperpigmentation, it is often difficult to elucidate the etiology of these conditions, which is important to guide management. Furthermore, certain disorders, such as lichen planus pigmentosus and ashy dermatosis, have similar clinical and/or histologic presentations, and their classification as distinct entities has been debated upon, leading to additional confusion. In this review, the authors selected commonly encountered disorders of hyperpigmentation of the skin, subdivided into epidermal, dermal, or mixed epidermal-dermal disorders based on the location of pigment deposition, along with disorders of hyperpigmentation of the mucosa and nails. Melanocytic nevi, genetic disorders, and systemic causes of hyperpigmentation were largely excluded and considered to be outside the scope of this review. We discussed the pathogenesis of hyperpigmentation as well as the clinical and histologic features of these conditions, along with challenges encountered in their diagnosis and classification. The second article in this 2-part continuing medical education series focuses on the medical and procedural treatments of hyperpigmentation. [ABSTRACT FROM AUTHOR]

Hyperpigmentation is a common complication in patients with burn injuries during wound healing; however, the mechanisms underlying its occurrence and development remain unclear. Recently, postinflammatory hyperpigmentation (PIH) was found to result from overproduction of melanin. Local or systemic inflammatory responses are often observed in patients who develop hyperpigmentation. However, we lack studies on the relationship between PIH and burn injury. Therefore, we comprehensively reviewed the existing literature on the melanogenesis of the skin, inflammatory mechanisms in pigmentation, and local or systemic alteration in inflammatory cytokines in patients suffering from burn trauma to elucidate the relationship between PIH and burn injury. We believe that this review will guide further research on regulating melanin production in the burn management process. [ABSTRACT FROM AUTHOR]

The CO2 laser has been widely utilized in dermatology; its expanding clinical applications include the management of neoplastic lesions, benign growths, cosmetic conditions, and reactive disorders. The laser’s popularity is mainly due to the high precision and short recovery time this technology provides. However, postinflammatory hyperpigmentation (PIH) has been one of the challenging adverse effects of the CO2 laser. Therefore, several modalities have been studied for the prevention of PIH following CO2 laser treatment. This review aims to analyze the incidence of PIH after CO2 laser therapy, identify its risk factors, and assess the efficacy of the examined treatment modalities in preventing PIH. Pubmed and Embase databases were searched for this study, and relative clinical trials were included in the review. Descriptive findings—including age, gender, skin type, types of intervention, and incidence of PIH—were reported. When appropriate, the incidence of PIH was compared across each possible individual factor, such as skin type, gender, and type of intervention. A total of 211 articles were identified, and 14 relevant articles were included in this review. Seventy percent of the subjects were females (n=219), and 30% were males (n=94), with a mean age of 30 years (SD=7.8). The most common skin types were type IV (59%) followed by type III (25%). In total, eight studies investigated the prevention of PIH. The incidence of PIH after CO2 laser significantly varies between studies, and differs based on the type of intervention. The studies indicate that the use of Clobetasol propionate 0.05% and fusidic acid cream appeared to effectively reduce PIH, recording an incidence rate of 39% and 53.3%, respectively. The Fitzpatrick-skin-phenotype did not appear to influence the risk of PIH. There is a lack of high-powered clinical studies analyzing the incidence of PIH after CO2 laser treatment and the associated risk factors. PIH occurrence may be related to inflammation resulting from thermal damage by the CO2 laser. Consequently, the use of postoperative topical medications with anti-inflammatory properties might reduce its incidence. The use of ultra-potent topical corticosteroids and topical fusidic acid appeared to reduce PIH, possibly reducing postoperative inflammation effectively. Similarly, platelet-containing plasma may be beneficial in reducing CO2 side effects, including PIH. However, more studies are needed to further establish the influence of skin type on PIH and investigate modalities to reduce PIH occurrence after CO2 laser use.

Hyperpigmentation disorders, such as post-inflammatory hyperpigmentation and melasma, are common conditions affecting all skin types. These conditions are largely benign and are influenced by numerous endogenous and exogenous factors impacting melanocyte activity and melanin production. Current treatment modalities for these conditions fall into broad categories, including photoprotection, topical and systemic therapies, chemical peels, and laser or light-based therapies. Biological differences in skin of colour require additional consideration when deciding on treatment and management. This narrative review provides an inclusive summary of these conditions and compares the current treatment options with a specific focus on skin of colour. Photoprotection and sunscreens protective against both UV and visible light are recommended for all individuals. Topical therapy is the recommended first-line treatment, with the gold standard being hydroquinone, which can be used alone or in combination with other agents. Chemical peels and laser or light-based therapies are also effective adjunctive methods of treatment; however, caution should be taken when used in patients with richly pigmented skin due to the increased risk of post-inflammatory hyperpigmentation.

Acne occurs in all races and ethnicities. In patients with pigmented skin, acne is very common. As far as the morphology of acne lesions is concerned, no significant differences exist between Caucasian and non-Caucasian skin; however, nodular acne is likely less frequent in patients with pigmented skin. The anatomic distribution of the lesions is similar in all races and ethnicities. Pomade acne is caused by the chronic application of oily products that are used to smooth the hair. It is characterized by more or less numerous closed comedones, with some papules and rare pustules, located on the forehead and temples. A very common and important complication of acne in patients with pigmented skin is postinflammatory hyperpigmentation. It is characterized by brown-to-black macules, of different morphology and size, located mainly on the face. Additional complications of acne in patients with pigmented skin are scars and keloids. The treatment of acne is superimposable in all phototypes. In order to improve tolerability and compliance of topical anti-acne therapy in patients with pigmented skin, it is helpful to begin the treatment with the lowest concentration of the drug, to use a cream or an aqueous gel as vehicle, to apply the drug every other day, with gradual increase to daily use, and to apply frequently a moisturizer. Furthermore, photoprotection is very important.

Tranexamic acid (TXA) is an antifibrinolytic agent approved for use to control bleeding during surgery and after trauma. It has been used in dermatology as a therapeutic and prophylactic agent in angioedema since 1970s but its recently discovered role in melasma has made it the current molecule of interest. At present TXA is being widely researched for multiple indications in view of its role in reducing melanogenesis and angiogenesis in skin. Various case reports and clinical trials have been published over the last few years describing its role in postinflammatory hyperpigmentation, dermal melanosis, rosacea, telangiectasia, and even as an antiaging agent. We present this review here summarizing the various publications for the aforementioned indications.

Background: Various pigment‐specific lasers can be used to treat solar lentigines. However, the most effective treatment options remain to be explored to reduce complications, such as postinflammatory hyperpigmentation, especially in dark‐skinned patients. Objectives: This study aims to compare the efficacy and safety between the KTP 532‐nm picosecond laser and the alexandrite 755‐nm picosecond laser for the treatment of solar lentigines in Asians. Materials and Methods: Thirty patients who had at least two solar lentigines on their arms were enrolled. A total of 30 paired lentiginous lesions were randomly selected for a single treatment with either a KTP 532‐nm picosecond laser or an alexandrite 755‐nm picosecond laser. Mean luminance score (L*) was evaluated at baseline and at 6 and 12 weeks to determine treatment efficacy. Improvement was assessed by a blinded physician using a 5‐point score. Satisfaction was rated by patients using a visual analog scale. All adverse events were documented. Results: All 30 patients completed the study. Both lasers showed significant improvement in mean L* from baseline (p < 0.001). With the parameter settings employed, lesions treated with the alexandrite 755‐nm picosecond laser showed greater improvement in mean L* when compared with treatment with the KTP 532‐nm picosecond laser at 12 weeks follow‐up (p = 0.002). According to physician scoring, more than 50% improvement was observed in 25 and 19 lesions of the alexandrite 755‐nm picosecond laser group and the KTP 532‐nm picosecond laser group, respectively. Adverse events did not differ between groups. A significantly higher satisfaction score was observed with the alexandrite 755‐nm picosecond laser at the last visit (p = 0.038). Conclusion: Both types of picosecond laser may be used to treat solar lentigines. Proper treatment settings and endpoint observation are the most important factor to achieve a successful outcome. [ABSTRACT FROM AUTHOR]

Given that some cutaneous mimics of child abuse result from a rare disease, they may be more prone to misdiagnosis. For possible child abuse cases in which diagnosis remains uncertain at the time of initial dermatologic evaluation, it is important that dermatologists are prepared to distinguish actual dermatologic conditions in cases of ambiguous skin findings. Additionally, this review will aid clinicians in recognizing the possibility of concurrent actual dermatologic disease and skin findings related to abuse with the acknowledgment that they are not mutually exclusive. A proper recognition of mimics of abuse may prevent unnecessary stress and child protective service investigation. [ABSTRACT FROM AUTHOR]

Topical measures are the mainstay treatment for postinflammatory hyperpigmentation (PIH). Numerous studies have assessed the efficacy of topical medications for the treatment of PIH, but few have evaluated the quality of evidence supporting these topical therapies. We performed a systematic review to evaluate the evidence of topical treatments for PIH. We included English-language studies that evaluated topical medications for PIH. We searched PubMed, MEDLINE, and EMBASE from conception to March 29 2021. We used the modified Grading of Recommendations, Assessment, Development and Evaluation scale (GRADE) scale to assess quality of evidence. Forty-seven of 1,224 studies with 1,853 subjects were included. Topical agents with high-quality studies included retinoids, hydroxy acids, corticosteroids, thiamidol, niacinamide and plant-derived products. Sunscreens with SPF30 or greater was recommended in almost every study. Common side effects included desquamation, burning, stinging, dryness, and pruritus. Retinoids, hydroxy acids and broad-spectrum sunscreen were supported by the greatest number of high-quality studies. Ongoing inflammation may be subtle, especially in darker skin phenotypes. Herein, we proposed an evidence-based algorithm for PIH based on the high-quality studies. There is a need to adopt a validated outcome measure for PIH to better compare efficacy between various treatments in future studies. [ABSTRACT FROM AUTHOR]

Background: Botulinum toxin type A (BTX‐A) has been used experimentally under various dermatological conditions. Recent studies have revealed a preventive effect of BTX‐A against ultraviolet B (UVB)‐induced skin hyperpigmentation. Objective: We examined the effect of BTX‐A for the treatment of UVB‐induced hyperpigmentation in humans. Material and methods: A prospective, double‐blind, randomized controlled trial was conducted. UVB irradiation induced five separate hyperpigmented squares on the abdomen. Seven days after irradiation, all squares were randomly assigned to five intervention groups: control, 0.9% normal saline injection, 12 units (1:2.5), 6 units (1:5), and 4 units (1:7.5) of onabotulinum toxin injections. The lightness index (L*), hyperpigmentation improvement score rated by a blinded physician, and participant satisfaction scores were obtained at 14, 21, and 28 days after injection. Results: Fifteen participants (mean age 36.9 years, Fitzpatrick skin types III‐IV) completed the study. The BTX‐A (1:2.5)‐treated site had a lower degree of hyperpigmentation at all time points, as measured by mean L* and hyperpigmentation improvement scores. However, there were no statistically significant differences between the groups. Participants were most satisfied with the control site. Conclusion: Intradermal BTX‐A injection had no therapeutic effect on UVB‐induced hyperpigmentation. However, the role of BTX‐A injections in the treatment of other hyperpigmentary conditions requires further elucidation. [ABSTRACT FROM AUTHOR]

The potential therapeutic effects of carnosic acid (CA) on postinflammatory hyperpigmentation (PIH) were evaluated, including its effects on melanin deposition in zebrafish, melanogenesis and melanosome transfer in skin cells and skin wound healing in mice. Our results demonstrated that CA dose-dependently decreased melanin deposition in the skin of juvenile zebrafishes. It also inhibited melanogenesis in melanoma cells and melanosome transfer to keratinocytes. Next, CA was loaded in a liposome-hydrogel system (LP-GEL) to treat skin wounds in mice. The results showed that CA-LP-GEL, as well as LP-GEL, could accelerate skin wound healing and repair the structure of healing skins in mice. Comparatively, the levels of inflammatory factors (IL-1β and TNF-a) in healing skins were significantly increased by LP-GEL, but reduced by CA-LP-GEL. In addition, Fontana-Masson staining analysis of healing skin showed that the melanoma cells were restored by the treatment of LP-GEL and CA-LP-GEL, while the melanin content was significantly increased only by LP-GEL. Real-time PCR data showed that CA decreased the gene expression related with melanogenesis (MITF, TYR and TRP-1), melanosome transfer (MLPH, Myova and Rab27a) and inflammatory cytokines (IL-1β and TNF-α) in vitro and in vivo. In conclusion, CA could reduce melanin deposition in the skin by inhibiting melanogenesis and melanosome transfer. CA-LP-GEL was found to accelerate skin wound healing and suppress inflammation and hyperpigmentation in mice. These results suggest that CA has a big developing potentiality for PIH treatment., Competing Interests: Declaration of Competing Interest The authors declare that this research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest. All authors read and approved the final manuscript., (Copyright © 2024 The Authors. Published by Elsevier Masson SAS.. All rights reserved.)

Background/objective: Laser therapy has emerged as a widely favored treatment option for solar lentigines (SL). However, a significant challenge associated with this treatment, particularly among individuals with darker skin tones, is the notable risk of postinflammatory hyperpigmentation (PIH) induction. In response to these concerns, the authors conducted a prospective, self-controlled study to comprehensively evaluate the safety and effectiveness of 532-nm picosecond laser, both with and without a microlens array (MLA), for the management of SL in patients with Fitzpatrick skin types (FST) III-V., Methods: Twenty-seven patients with FST III-V and bilateral SL on the face underwent randomized treatment. One side of the face was treated with a 532-nm picosecond laser coupled with an MLA, utilizing the fractional pigment toning (FPT) technique, while the other side received treatment without the MLA, following the conventional technique (CT). The FPT technique utilized a 9-mm spot size with a fluence of 0.47 J/cm 2 for two passes covering 40% of the area. In contrast, the CT used a 4.5-mm handpiece with fluence ranging from 0.3 to 0.7 J/cm 2 . Patients received a single treatment and were evaluated for pigment clearance, occurrence of PIH, and other adverse effects at 2 weeks, 1, 3, and 6 months posttreatment., Results: Twenty-seven participants completed the study protocol. Analysis of pigment clearance, measured via 3D photography, showed significant improvement from 2 weeks to 6 months posttreatment for both the FPT technique (p < 0.001) and CT (p = 0.004). PIH occurred in 64%, 80%, 96%, and 88% of cases on the CT side, compared to 8%, 32%, 36%, and 16% on the FPT technique side at 2 weeks, 1, 3, and 6 months posttreatment, respectively. The incidence of PIH was significantly lower on the FPT technique side compared to the CT side throughout the follow-up periods. Additionally, transient and mild hypopigmentation occurred in one participant (4%) on the FPT technique side and in five participants (20%) on the CT side. No other adverse effects were observed during the study., Conclusions: The 532-nm picosecond laser emerges as a safe and efficacious treatment modality for SL in individuals with FST III-V. Particularly noteworthy is the efficacy of the FPT technique, which demonstrates comparable effectiveness while significantly reducing the incidence of PIH compared to the CT., (© 2024 The Author(s). Lasers in Surgery and Medicine published by Wiley Periodicals LLC.)

Postinflammatory hyperpigmentation (PIH) is a disorder of pigmentation that is a common presenting complaint, especially in individuals with skin of color. It is associated with a significant psychological burden and decrement of quality of life. Management options include photoprotection, topical lightening agents, and lasers and energy devices. Clinical trials of melasma report a diversity of outcomes, which often impedes synthesis of results across trials, or comparison of results associated with different treatment modalities. This protocol describes the design of a consensus process that would culminate in the development of a core set of outcomes to be assessed in all clinical trials for PIH. A long list of candidate outcomes will be developed through a systematic review, combined with semi-structured interviews with various stakeholders, including patients, scientists, regulators, and health care professionals. This long list of outcomes will be reviewed and refined by a steering committee. Then two rounds of Delphi surveys of patient and physician groups, respectively, will be used to cull the list, with provisional inclusion of those items deemed "important" by 70% of the respondents. A consensus meeting will be held virtually or in person to vote on these items, and also to consider any changes necessary before acceptance of a final core outcome set. Development of a core outcome set for PIH is expected to improve and standardize outcomes reporting in current and future clinical trials. This, in turn, may facilitate aggregation of research results and permit comparison of outcomes across multiple studies. [ABSTRACT FROM AUTHOR]

Background: Epidermal growth factor (EGF) may promote wound healing and decrease laser‐induced postinflammatory hyperpigmentation (PIH). Objectives: To evaluate the effectiveness of an EGF‐containing cream on PIH, post‐laser erythema, and transepidermal water loss (TEWL) after 1,064‐nm Q‐Switched Nd: YAG laser treatment of Hori's nevus. Methods: This is a split‐face, double‐blinded, randomized, controlled study conducted in 30 subjects with bilateral Hori's nevus. After laser treatment, participants were randomized to apply EGF cream on one facial side and placebo on the other side for 8 weeks. The incidence and intensity of PIH were assessed by photographs and melanin indexes (MIs) ratio at baseline, Week 2, Week 4, and Week 8. Post‐laser erythema and TEWL were measured at baseline, Day 1, Day 3, and Day 7. Side effects and patient satisfaction score were evaluated. Results: The incidence of PIH was 26.7% in EGF group compared to 20% in placebo. The intensity of PIH was 0.057 (0.033–0.086) and 0.045 (0.027–0.076) in EGF and placebo group, respectively. There was no significant difference in both incidence (p = 0.5) and intensity of PIH (p = 0.145). Post‐laser erythema was not statistically different between groups. EGF could alleviate TEWL better than placebo but without statistical significance. Patient satisfaction score was significantly higher in EGF group compared to placebo (p < 0.001). Conclusions: The EGF‐containing cream could not prevent PIH. It may reduce laser‐induced skin barrier damage. Future studies in more subjects are needed. [ABSTRACT FROM AUTHOR]

Tranexamic acid (TXA) is an antifibrinolytic agent approved for use to control bleeding during surgery and after trauma. It has been used in dermatology as a therapeutic and prophylactic agent in angioedema since 1970s but its recently discovered role in melasma has made it the current molecule of interest. At present TXA is being widely researched for multiple indications in view of its role in reducing melanogenesis and angiogenesis in skin. Various case reports and clinical trials have been published over the last few years describing its role in postinflammatory hyperpigmentation, dermal melanosis, rosacea, telangiectasia, and even as an antiaging agent. We present this review here summarizing the various publications for the aforementioned indications. [ABSTRACT FROM AUTHOR]

Objective To observe the therapeutic effect of sonophoresis vitamin E on postinflammatory hyperpigmentation after facial second degree burn. Methods All the 36 patients with facial second degree treated in our hospital between September 2019 and September 2020 were recruited in this study. Twenty-four of them were randomly assigned into the observation group (n=12) and the control group (n=12), and the other 12 who refused treatment were automatically assigned to the blank control group (n=12). The observation group was treated with vitamin E (0.5~1 mL, twice per day) by sonophoresis (frequency 1 MHz, intensity 0.8 W/cm2, twice per day), while the control group was only treated with vitamin E, and the blank control group was not treated with vitamin E. And the 3 groups of patients followed strictly physical sunscreen for facial skin. After 2 and 4 weeks of treatment, the curative effects were observed and compared among the 3 groups. Results After 2 weeks, the total effective rate was 83.33% in the observation group, 66.67% in the control group, and 8.33% in the blank control group; And significant difference in the rate was observed among the 3 groups (P=0.001). In 4 weeks after treatment, the total effective rate was 83.33% in both the observation group and the control group, obviously higher than that of the blank control group (25.00%, P=0.011). The observation group obtained less pigment area and weaker pigment intensity when compared the other 2 groups in 2 and 4 weeks after treatment (P < 0.05), and the conditions in the pigmentation were better in the control group than the blank control group (P < 0.05). With time elapsing, the pigment area and pigment intensity were in a trend of decreasing in all of the 3 groups. The conditions after 4 weeks' treatment were greatly improved than those at 2 weeks in the control group (P < 0.05). Those at 2 weeks in the observation group were similar to those in the control group after 4 weeks' treatment (P>0.05). Conclusion Vitamin E though sonophoresis can effectively improve the postinflammatory hyperpigmentation and shorten the effective time for facial burn.

Michal Szczepanek, Aleksandra Frątczak, Anna Lis-Święty Department of Dermatology, School of Medicine in Katowice, Medical University of Silesia, Katowice, PolandCorrespondence: Anna Lis-ŚwiętyDepartment of Dermatology, School of Medicine in Katowice, Medical University of Silesia, Francuska 20/24, Katowice, 40-027, PolandTel +48 602720948Email annadlis@neostrada.plBackground: Localized scleroderma (LoS) is an inflammatory fibrosing disease of the connective tissue, whose esthetic sequelae are atrophic skin lesions with hyperpigmentation. The key element of diagnostic and therapeutic procedures is the assessment of the disease’s severity and damage. The study objective was to analyze the usefulness of narrow-band reflectance spectrophotometry (NBRS) to assess erythema and hyperpigmentation in LoS lesions.Materials and Methods: Erythema indexes (EI) and melanin indexes (MI) were determined with the use of DermaLab Combo skin colour probe for LoS lesions and symmetrically located areas of normal skin. Then, relative percentage differences were determined for EI and MI, which were compared with the visual assessments of erythema and hyperpigmentation according to the Localized Scleroderma Cutaneous Assessment Tool (LoSCAT).Results: A total of 84 LoS lesions were studied in 41 patients. The study showed a moderate correlations between the spectrophotometric measurements and clinical assessments of erythema as well as hyperpigmentation (Spearman correlation coefficient, r), r = 0.37; p = 0.00047 and r = 0.55; p=0.0000001, respectively.Conclusion: NBRS seems to be a useful tool to assess the severity of erythema and hyperpigmentation in LoS lesions. Further studies are required in order to compare the spectrophotometric results with other objective methods.Keywords: colour, erythema, morphea, postinflammatory hyperpigmentation

Background: Hyperpigmentation is a common concern of patients in dermatology clinics. Although there are many treatment options, lasers are considered a promising therapy for various hyperpigmentary conditions. Objectives: This study aims to evaluate the efficacy of alexandrite 755‐nm picosecond and neodymium‐doped yttrium aluminum garnet (Nd:YAG) 1064‐nm picosecond lasers for the treatment of ultraviolet B (UVB)‐induced hyperpigmentation in Asians. Materials and Methods: A randomized, single‐blinded study was conducted. UVB‐induced hyperpigmentation was performed in three spots by narrowband UVB. After 2 weeks, these three spots were allocated into 755‐treated, 1064‐treated, and control sites. Patients received weekly laser treatments for five sessions. Follow‐ups were scheduled at 1 and 2 months after the last session. Results: Twenty patients attended the study. Overall, 755‐nm and 1064‐nm picosecond lasers showed a significant improvement in the mean lightness index (L*) compared to the control site, which started at Day 49 and Day 77, respectively. The mean L* of the 755‐nm‐treated site was also higher than that of the 1064‐nm–treated site at Day 105 (p ≤ 0.001). Initially, the mean L*, physician's visual analog scale (VAS), and patient satisfaction with the 1064‐nm picosecond laser were better than those with the 755‐nm picosecond laser. Nevertheless, an inversion of the mean L* and VAS was noted at Day 49, whereas the mean patient satisfaction was noted at Day 77. In the subgroup analysis, a 755‐nm picosecond laser effectively treated Fitzpatrick skin types (FPTs) III and IV. However, the mean L* of the 1064‐nm picosecond laser was not significantly different from that of the control for FPT4. Conclusion: The alexandrite 755‐nm picosecond and Nd:YAG 1064‐nm picosecond lasers appear to be effective and safe modalities for treating UVB‐induced hyperpigmentation. With the setting employed in this study, the outcome after the 755‐nm picosecond laser treatment seemed superior to that of the 1064‐nm picosecond laser treatment, especially for FPT4. [ABSTRACT FROM AUTHOR]

Introduction/Objectives: Acne is present in about 90% of teenagers and 12% to 14% of adults. Face and trunk are the most affected areas. Lesions can result in postinflammatory hyperpigmentation and scarring, leading to reduced quality of life. Asynchronous teledermatology has been increasingly used around the world, facilitating patient access to dermatologists. Our objectives were to assess: (1) clinical features of acne patients according to gender, age, severity, site of lesions, excoriation, postinflammatory hyperpigmentation (PIH), and atrophic scar (AS) and (2) how many referrals to in-person consultations with dermatologists could be avoided using asynchronous teledermatology in primary care attention? Methods: We analyzed images, demographic and clinical data of 2459 acne patients assisted by teledermatology, with the aim to confirm the diagnoses, to classify acne severity according to grades I to IV, and to search for the presence of postinflammatory hyperpigmentation, atrophic scars, and/or excoriated acne (EA). We compared the clinical and biological data, looking for associations among them. Results: Acne severity and age were associated with the most common sequels: postinflammatory hyperpigmentation (mainly on the trunk and in females, P <.0001) and atrophic scars (mainly on the face and in males, P <.0001). We also observed different frequencies according to age and sex: 13 to 24 years in males (P =.0023); and <12 (P =.0023) and 25 to 64 years old (P <.0001) for females; 68% of the patients had no need for in-person dermatologists' referral, being kept at primary care attention with proper diagnosis and treatment. Conclusion: Clinical features of acne and its sequels differ according to gender, age, site, and severity. The new findings of PIH associated with women and AS, with men, may help offer a more personalized management to patients. Teledermatology was suitable for the majority of the acne cases in primary care. [ABSTRACT FROM AUTHOR]

Acne occurs in all races and ethnicities. In patients with pigmented skin, acne is very common. As far as the morphology of acne lesions is concerned, no significant differences exist between Caucasian and non-Caucasian skin; however, nodular acne is likely less frequent in patients with pigmented skin. The anatomic distribution of the lesions is similar in all races and ethnicities. Pomade acne is caused by the chronic application of oily products that are used to smooth the hair. It is characterized by more or less numerous closed comedones, with some papules and rare pustules, located on the forehead and temples. A very common and important complication of acne in patients with pigmented skin is postinflammatory hyperpigmentation. It is characterized by brown-to-black macules, of different morphology and size, located mainly on the face. Additional complications of acne in patients with pigmented skin are scars and keloids. The treatment of acne is superimposable in all phototypes. In order to improve tolerability and compliance of topical anti-acne therapy in patients with pigmented skin, it is helpful to begin the treatment with the lowest concentration of the drug, to use a cream or an aqueous gel as vehicle, to apply the drug every other day, with gradual increase to daily use, and to apply frequently a moisturizer. Furthermore, photoprotection is very important. [ABSTRACT FROM AUTHOR]

Background: Tranexamic acid has been reported to benefit the treatment of postinflammatory hyperpigmentation (PIH). Laser-assisted drug delivery (LADD) could facilitate the efficacy of topically applied drugs into the dermis. This split-area randomized prospective study aims to assess whether early utilization of the LADD procedure with tranexamic acid delivery followed by picosecond lasers can attenuate the PIH better than the utilization of picosecond lasers alone. Patients and methods: Ten post-traumatic cases of PIH in 10 patients (8 female and 2 male) with an average age of 34.2 - 11.2 years were included in this clinical trial. Using block randomization to determine the treatment side, one side of each area of the PIH was separated from the midline into two halves belonging to the control and tranexamic acid groups. The half area of the tranexamic acid group was further topically applied with 10% tranexamic acid solution. This procedure was repeated every 6 weeks, four times in total. Results: The self-assessment of the hyperpigmentation and overall satisfaction of the treatment outcome were not significantly different between the treatment and control sides. Conclusions: This split-area study revealed that, compared with picosecond alone, there was no significant difference adopting tranexamic acid in LADD after nonablative fractional picosecond laser for PIH. [ABSTRACT FROM AUTHOR]

Photosensitive conditions such as melasma and postinflammatory hyperpigmentation (PIH) are exacerbated by exposure to ultraviolet (UV) rays and visible light making sunscreen use an essential component of treatment. This is especially true in skin of color patients who are less likely to use photoprotection, even if diagnosed with these photoexacerbated conditions. We aimed to evaluate the body of literature to provide evidence for the use of sunscreen in the treatment of melasma and PIH. We reviewed English articles from PubMed, Journals@Ovid Full Text, and Embase using the search terms “sunscreen” and either “melasma” “PIH,” or “post-inflammatory hyperpigmentation.” Nine relevant publications provide evidence that a broad spectrum of protection, including UVA, UVB, and visible light within sunscreens can play an adjuvant role in therapy for melasma and PIH by stabilizing and improving these pigmentary disorders in skin of color patients. This review illustrates the advantages and limitations of sunscreen use, as well as practice gaps in photoprotection in the skin of color patients with melasma and PIH.

Background: There is a lack of evidence on the therapeutic efficacy of topical tranexamic acid (TA) for the treatment of acne-related postinflammatory hyperpigmentation (PIH). The current study aimed to assess the efficacy of twice-daily administration of 20% azelaic acid (AZA) cream versus 5% TA solution for the treatment of PIH in patients with acne vulgaris. Materials and Methods: Patients in the present single-blinded randomized clinical trial were randomized into AZA or TA groups for 12 weeks. The rate of healing was assessed by scoring recorded photographs based on postacne hyperpigmentation index (PAHI) at baseline, 4th, 8th, and 12th weeks. The frequency of side effects was examined and recorded at each study time point. Results: Thirty volunteers in each treatment group completed the intervention. PAHI score in both AZA and TA groups improved during the study course (Ptime < 0.001, for both groups). However, mean PAHI scores were comparable in the two groups (Pgroup = 0.05). No significant interaction was also found between time and treatments in terms of PAHI score (Ptime × group = 0.66). The frequency of treatment-related side effects was significantly higher in the AZA group compared to the TA group at week 4 of treatment (P < 0.05). However, no significant difference was observed in the frequency of reported side effects at weeks 8 and 12 of the treatment (P > 0.05). Conclusion: Topical administration of 20% AZA cream and 5% TA solution was comparably efficient in the treatment of acne-related PIH with a significantly better safety profile of TA in the 1st month of the treatment.

Background: Axillary hyperpigmentation (AH) is a condition in which axillary skin is darker than the adjacent areas. To date, there is no standard treatment for AH. The Q‐switched neodymium‐doped yttrium aluminum garnet 1064‐nm(QS) laser and intense pulsed light (IPL) are two effective modalities for the treatment of pigmentary disorders; however, the efficacy and safety levels of both treatments for AH have not yet been compared in a controlled study. Aims: To evaluate and compare the efficacy and safety of the QS laser and IPL in the treatment of AH. Methods: A randomized, split‐side study was conducted on 22 subjects; all subjects received a total of five split‐side treatments every 2 weeks. The efficacy was determined using the melanin index (MI), color chart level using the Pantone SkinTone™ Guide, improvement grading scale (IGS), and patient satisfaction scores at weeks 2, 4, 6, 8, and 10. Results: The results showed that there was no significant difference in MI, color chart level, IGS, and patient satisfaction scores between the two treatments. Both treatments significantly improved AH after three sessions. However, the pain score was lower for IPL treatment. The adverse effects were transient and were found after IPL treatment in one participant (4.45%) who developed hyperpigmentation and another participant (4.45%) who developed erythema. Conclusions: Intense pulsed light therapy is safe and effective for the treatment of AH, with no significant difference in the outcome compared with QS laser treatment. [ABSTRACT FROM AUTHOR]

The color of human skin varies according to race, ethnicity, and geographic location, which leads to differing appearances of the same cutaneous condition. The nonwhite population is projected to increase worldwide in the coming decades owing to globalization and changing demographics. Thus, this review aims to focus on the varying nature of cutaneous conditions in this population, which differ from traditional descriptions in textbooks. A thorough search of PubMed, MEDLINE, Cochrane, and Google Scholar databases was done for relevant articles focusing on appearances of various dermatoses in skin of color. Erythematous diseases such as psoriasis, pityriasis rosea, and atopic dermatitis presented with inconspicuous/less conspicuous erythema in individuals with colored skin. Postinflammatory pigmentary changes were frequent in individuals with Fitzpatrick Grading III to VI and in the darker phenotypes, the hyperpigmentation may be difficult to distinguish from normal skin color. Acne hyperpigmented macules are encountered as primary lesions in colored skin, causing a considerable amount of apprehension in affected individuals. Hypopigmented disorders such as arsenicosis, macular postkala-azar dermal leishmaniasis, and dhoti or saree-induced depigmentation were particularly observed in this population. A focused review addressing the visual aspects, especially the color of skin diseases in individuals with Fitzpatrick Grading III to VI is the need of the hour to sensitize dermatologists regarding the specific dermatoses and reaction patterns occurring in this population. [ABSTRACT FROM AUTHOR]

Background: Isobutylamido thiazolyl resorcinol (ITR) is a novel anti‐tyrosinase recently shown to be effective in the treatment of hyperpigmentation. Low‐fluence Q‐switched Nd:YAG 1064‐nm laser (LFQS) has proven to be effective for various hyperpigmentary conditions. However, there is no study on the efficacy and safety of combined ITR and LFQS treatment. Objectives: To compare the efficacy and safety of combined ITR and LFQS with LFQS monotherapy for facial hyperpigmentation. Materials and Methods: Patients with symmetrical facial hyperpigmentation were treated with five sessions of once weekly LFQS on the whole face. One side was randomly treated with ITR and the other side received a placebo cream for 12 weeks. Patients were followed for 8 weeks after the last laser treatment. Relative lightness index (RL*I), Facial Hyperpigmentation Severity Score on the malar area (FHSSm), patient satisfaction, recurrence, and adverse events were recorded. Results: Twenty‐four patients completed the study. Both sides demonstrated significant reductions of mean RL*I and mean FHSSm from baseline (P <.01). At the 4th week, the ITR‐treated side showed more improvement of mean RL*I than the placebo‐treated side (62.5% vs 47.3% improvement, P <.05). The mean FHSSm on the ITR‐treated was reduced at a significantly higher percentage than the placebo‐treated side (54.4% vs 40.2% reduction, P <.05). Partial recurrence was observed on both sides. No serious side effects were noted. Conclusion: Combined ITR and LFQS therapy was more superior than LFQS monotherapy in the treatment of facial hyperpigmentation. ITR may serve as adjuvant for patients with such condition. [ABSTRACT FROM AUTHOR]

Background: The potential efficacy of vascular component‐targeted laser has been evaluated for the treatment of melasma, which commonly found with the co‐existence of telangiectasia. Aims: To evaluate the treatment efficacy and safety of 585‐nm QSNYL and 4% HQ cream combination vs 4% HQ cream alone for telangiectatic melasma in the skin phototypes III‐V. Patients/Methods: Twenty‐one Thai female patients with telangiectatic melasma and Fitzpatrick skin phototypes (FPTs) III‐V were randomly treated with the 585‐nm QSNYL on one side of the face for five sessions at 2‐week intervals. All patients were assigned to apply HQ cream daily at night on both sides of the face for 10 weeks and a broad‐spectrum sunscreen regularly throughout the study. The treatment efficacy and safety were evaluated using the Modified Melasma Area and Severity Index (mMASI), biometric evaluation, patient assessment, and adverse effects. Results: The combination‐treated side yielded more significant improvement of mMASI than the topical‐treated side at weeks 2, 4, and 8, respectively. However, 19% of the patients developed postinflammatory hyperpigmentation (PIH) on the laser‐treated side, especially in FPTs IV‐V and rebound hyperpigmentation. There was a significant improvement of hemoglobin and melanin index, but without statistical difference between the two treatment groups. Conclusions: The combination of 585‐nm QSNYL and HQ treatment yields treatment efficacy and skin rejuvenation effects for telangiectatic melasma. Nonetheless, a high incidence of PIH and rebound hyperpigmentation is adversely developed in dark FPT. Thus, this laser treatment should be cautiously applied in those with dark FPTs IV‐V to avoid laser‐induced pigment alteration. [ABSTRACT FROM AUTHOR]

Postinflammatory hyperpigmentation (PIH) is an acquired hypermelanosis arising after inflammation or injury to the skin and can develop in all skin types especially in Fitzpatrick skin phototypes III to VI. In higher skin phototypes, chances of PIH following procedures using laser and other light sources are high. Therefore, it is becoming increasingly important to manage this unforeseen condition. Wide variety of treatment options are available for PIH, but there is limited literature regarding efficacy and safety of chemical peels in PIH. Hence, a thorough systematic review was performed by searching Pubmed, Scopus, Medline, and Cochrane databases in English language involving studies on PIH. Thus, this article is an attempt to bring together all the possible ways of using chemical peels (alone, in combination with other peels or topical agents) for the management of PIH.