Hyperpigmentation: A leading reason why skin of colour patients seek dermatologic care

Post-inflammatory hyperpigmentation is more common in darker-skinned patients, according to Dr. Katie Beleznay (500 words, 3 min. reading time)

“Post-inflammatory hyperpigmentation is one of the top reasons that skin of colour patients seek dermatological care,” said Dr. Katie Beleznay in a presentation at Skin Spectrum Summit in Vancouver.

Dr. Beleznay emphasized how early and effective intervention is essential to prevent pigmentary issues and scarring. Specifically, she discussed how keloid scarring is more common in skin of colour. Also, for skin of colour patients, some hair-grooming products may cause or worsen acne, leading to what Dr. Beleznay described as “pomade acne.” 

After inflammatory wounds, the pigmentation of the skin can occur. Post-inflammatory hyperpigmentation is more common in darker-skinned patients, whereas post-inflammatory erythema is more common in patients with lighter skin types. Dr. Beleznay stressed that these skin discolourations, although they are not true scars as the skin is not pitted or depressed, can last for years.

Therefore, “it is important to set up expectations, how to treat this, when will it fade, so [patients] are not thinking it is going to be gone the next day,” said Dr. Beleznay. 

Epidermal lesions may persist for up to six to 12 months, but dermal hyperpigmentation can last for years and may be more disconcerting than acne. Facial acne scarring occurs in 95% of patients and develops within 12 weeks. Dr. Beleznay described how facial acne scars could manipulate an individual's perception, presenting a survey that found that people with clear skin are more often associated with positive traits. 

Dr. Beleznay suggested using oral antibiotics, which can be less irritating to the skin than topical therapies. She named isotretinoin a potentially remissive treatment for acne, which was safe and effective in African-American, Middle Eastern, Asian and Asian-Indian populations. Isotretinoin reduces sebum production by 70%, reverses follicular hyperkeratosis to normalize epidermal differentiation, reduces P. acnes and inhibits the inflammatory reaction, which reduces the amount of neutrophils attracted to the troubled site. 

In terms of scarring with the use of isotretinoin, Dr. Beleznay advised that “less scarring develops in those receiving isotretinoin early in their dis-ease process.” 

The takeaway: Dr. Beleznay stressed that it is important to be clear with patients as treating acne and acne scarring can be an expensive and lengthy endeavour.

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FROM THE LITERATURE ON HYPERPIGMENTATION

Skin hyperpigmentation in coronavirus disease 2019 patients: Is polymyxin B the culprit?

  • A recent study looked at two cases of cutaneous hyperpigmentation of two Chinese patients diagnosed with Covid-19; the incidence is higher in darker-skinned patients. Researchers found that the hyperpigmentation may have been caused by the antibiotic polymyxin b.

    From “Frontiers in Pharmacology”

Efficacy of topical antioxidants in the skin hyperpigmentation control: A clinical study by reflectance confocal microscopy

  • Brazilian researchers have assessed the efficacy of antioxidants in reducing skin hyperpigmentation, finding that they were effective in significantly reduce it. The study was conducted on thirty-two healthy female subjects between the ages of 39 and 55 who were evaluated over a 42-day period.

    From “Journal of Cosmetic Dermatology”

Medication-induced oral hyperpigmentation: A systematic review

  • According to a recent study, medications such as antimalarials, antibiotics, antineoplastic, and chemotherapies carry an increased risk of causing oral hyperpigmentation. The literature review, conducted by researchers in Saudi Arabia, looked at 57 studies to better understand what causes medication-induced oral hyperpigmentation and which populations are most at risk, finding that women were more susceptible. 

    From “Patient Preference and Adherence”

AT THE INTERSECTION OF SKIN AND SOCIETY

  • In a recent article, the Washington Post examined Brazil's people's complex racial makeup and how some are coming to a new understanding of their own ethnicity. The article looks at the issue through the lens of a Brazilian man who confronts his racial identity perception when running for local office. According to his interview, until the recent racial justice movement in the United States brought on by the killing of George Floyd, José Antônio Gomes of the Brazilian city Turmalina had considered himself mixed race. “In reality, I’ve always been Black,” he said. “But I didn’t think I was Black. But now we have more courage to see ourselves that way,” he said. Read the full article here.

This Week

  • Monday, Nov. 30 is Stomach Cancer Awareness Day

  • Tuesday, Dec. 1 is World AIDS Day

  • Wednesday, Dec. 3 and Saturday, Dec. 5, Real World Medicannabis Symposium (a conference organized by Chronicle Companies for physicians interested in the therapeutic use of cannabinoids. Speakers include Dr. Sheldon Pollack and Dr. Wayne P. Gulliver. Registration is free for this two-day event.)

Something to think about during the week ahead…

Next Week

Dr. Gary Sibbald discusses preventing diabetic foot ulcers by outlining treatment for onychomycosis and toe web bacteria. Subscribe to Skin Spectrum Weekly and have each issue sent directly to your phone or inbox.

Thank you to our panellists and delegates for making Skin Spectrum Summit 2020 a great success. Conference highlights will soon be posted to the Skin Spectrum website. As always, we welcome your questions and comments on topics in Ethnodermatology.

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