New scale for post-inflammatory hyperpigmentation
Validation study suggests new tool will support quick, accurate assessment of pigment change in all skin types (1,500 words, 7 minutes, 30 seconds)
Researchers have validated a novel scale for analyzing hyperpigmentation in a diverse U.S. population of varying skin tones. The scale is intended to easily characterize pigment changes due to any cause anywhere on the body.
The authors of a recent paper published in JAAD on March 19, 2024, make noteworthy observations about the assessment of skin changes in inflammatory diseases. They point out that the current gold standard, Investigator’s Global Assessment, doesn’t have a specific variable for dyspigmentation. Moreover, they suggest that the Postinflammatory Dyspigmentation Area and Severity Index (PIDASI) has some limitations, as it allows for only one pigmentation score, regardless of the heterogeneity of pigmentation. These insights could help researchers and clinicians develop more precise and comprehensive tools to evaluate skin changes in patients with inflammatory diseases.
Their study aimed to validate the PIDASI in a diverse population and to assess the performance of a novel Post Inflammatory Hyperpigmentation Area and Severity Index (PIHASI) scale.
“Our study demonstrates that both the PIDASI and PIHASI tools perform well in patients of a variety of skin types with post-inflammatory hyperpigmentation and are reliable and valid alternatives to the commonly used metric to measure the severity of skin changes from inflammatory diseases,” said corresponding author Neelam Vashi, MD. Dr. Vashi is an Associate Professor of Dermatology at Boston University Chobanian & Avedisian School of Medicine and director of the Boston University Cosmetic and Laser Center at Boston Medical Center.
The researchers found that both PIDASI and PIHASI corresponded to objective measurements of disease severity.
According to the study authors, the PIHASI scale will allow providers to better characterize a patient’s hyperpigmentation and will be vital in hyperpigmentation research to better quantify response to treatment.
Bottom line: No globally accepted, dedicated tool for evaluating post-inflammatory hyperpigmentation exists. Researchers have developed and validated a new scale, the Post Inflammatory Hyperpigmentation Area and Severity Index, that they say should make quantifying pigment changes more accessible and accurate. This has implications for both research and patient care.
From the literature on dyspigmentation
Efficacy and safety of novel topical pigment-correcting regimen with biweekly diamond tip microdermabrasion procedures on facial hyperpigmentation
This study was conducted to assess the safety and tolerability of a combination of diamond-tip microdermabrasion procedures using a novel brightening pro-infusion serum with a targeted at-home treatment regimen in subjects with mild to severe facial hyperpigmentation, including melasma, post-inflammatory hyperpigmentation, and dark spots.
The researchers enrolled 18 subjects with Fitzpatrick skin types I to IV. Participants underwent six biweekly in-office microdermabrasion procedures with the novel serum and daily topical application of a brightening serum and a dark spot cream.
Investigators found the combination treatment was well tolerated and resulted in significant (p≤0.05) improvements from baseline in radiance, tactile roughness, and moisturization/hydration immediately after the first treatment, in Melasma Area and Severity Index score at day three, and overall hyperpigmentation at week four. Most (94.1%) subjects were satisfied with the treatment.
Advancements in laser therapies for dermal hyperpigmentation in skin of colour: A comprehensive literature review and experience of sequential laser treatments in a cohort of 122 Indian patients
This comprehensive review explores the mechanisms, applications, and recommendations for pigmentary laser technologies in treating dermal hyperpigmentation in darker skin types. It highlights the critical role of Q-switched lasers in their established millisecond and nanosecond forms, emerging picosecond lasers, fractional non-ablative and ablative lasers, Intense Pulsed Light, etc.
The authors include studies on dermal melanocytosis (nevus of Ota and Hori's nevus), tattoos, acquired dermal macular hyperpigmentation, and also entities with mixed epidermal-dermal components, such as melasma and post-inflammatory hyperpigmentation.
They provide insights for clinicians to make informed decisions based on diagnosis, skin type, and the latest technologies to optimize results and minimize complications, especially in darker Fitzpatrick skin types.
In an associated five-year study with 122 Indian patients, the authors applied specific laser combinations for diverse dermal melanoses, including tattoos, dermal/mixed melasma, acquired dermal macular hyperpigmentation, and dermal nevi. They observed substantial pigmentation reduction, subjectively assessed by physicians and patients, across all groups. Statistical analysis showed a significant difference in mean improvement scores across various pigmentary conditions (F=3.39, p=0.02), with melasma patients exhibiting a significantly higher improvement score than tattoos (p=0.03).
Efficacy and safety of the combination of oral tranexamic acid and intense pulsed light versus oral tranexamic acid alone in the treatment of refractory Riehl's melanosis: A prospective, comparative study
Noting there is no standardized and effective treatment modality for Riehl’s melanosis, researchers compared the efficacy and safety of oral tranexamic acid (TXA) combined with intense pulsed light (IPL) versus TXA alone in the treatment of refractory lesions in this condition.
This prospective study included 28 subjects with refractory Riehl's melanosis and Fitzpatrick Skin Types III or IV. All subjects received oral TXA 500 mg daily, and 11 were treated in combination with monthly IPL therapy for six months. The primary outcome measures were mean melanin index (MI), erythema index (EI), and acquired dermal macular hyperpigmentation area and severity index (DPASI). The Physician Global Assessment (PGA) and patient satisfaction scale were documented.
Researchers observed that DPASI, mean MI, and EI were significantly reduced in both groups after treatment. The group treated with combination therapy showed better improvement according to MI (p=0.0032) and DPASI (p=0.00468). PGA and the patient satisfaction scale showed superior efficacy in the combination group. The investigators observed no significant difference in treatment-related side effects.
The 730 nm picosecond titanium sapphire laser for treatment of café-au-lait macules in all skin types
Investigators retrospectively reviewed patients with café-au-lait macules (CALM) treated with 730-nm picosecond titanium sapphire laser at a single institution between April 2021 and Dec. 2023. Three outside board-certified dermatologists graded clinical photographs using a five-point visual analog scale.
Physicians treated 14 patients aged 10 months to 66 years (mean age 27.4 years) with Fitzpatrick skin types II to VI for CALM on the face (11) or body (three). On average, the patients received 4.3 treatments, with treatment intervals ranging from four to 40 weeks. Treatment remains ongoing with the 730-nm picosecond laser for eight patients.
Overall, patients were rated to have a mean improvement of 26% to 50%. Two patients (skin types III and VI) achieved 100% clearance after four to five treatment sessions.
The authors note the study included four patients whose CALM were of the smooth-bordered “coast of California” subtype, three of whom had a mean improvement rating of only 1% to 25%. The fourth patient had near-complete resolution. Follow-up for these patients has ranged from six weeks to 1.5 years. Of the patients treated, one patient experienced transient post-inflammatory hyperpigmentation and another transient post-inflammatory hypopigmentation, while a third patient experienced mild persistent guttate hypopigmentation. Three patients experienced partial recurrence, indicating that some patients may need maintenance treatments.
VIDEO: Oral tranexamic acid for pigmentation
Consultant dermatologist Dr Paul Devakar Yesudian (Chester, U.K.) discusses pigmentary dermatoses that could benefit from treatment with oral tranexamic acid used off-label. He touches on dosages and potential side effects.
At the intersection of skin and society
Vancouver’s Chinese Canadian Museum (CCM) has announced that it will tour highlights of its feature exhibition, “The Paper Trail to the 1923 Chinese Exclusion Act,” to museums across Canada in May 2024. According to the announcement, the tour is being conducted in recognition of Asian Heritage Month.
The Paper Trail exhibition examines the period from 1923 to 1947 when Canada imposed a head tax and immigration certificates that prevented Chinese immigrants from entering Canada. It includes stories of loss, despair, and fear and “examples of courage and perseverance despite incredible odds.”
The exhibition will be in the following locations:
Toronto: Toronto Reference Library (Beeton Hall)—May 6 from 6:30 p.m. to 8 p.m.
Gatineau, Que.: Canadian Museum of History—May 23 from 5:30 p.m. to 7:30 p.m.
St. John’s, NL: The Rooms—May 29 from 6 p.m. to 8 p.m.
Halifax: Canadian Museum of Immigration at Pier 21—May 31 from 4 p.m. to 6 p.m.
“We are honoured to bring highlights of our feature exhibition, The Paper Trail to the 1923 Chinese Exclusion Act, to new Canadian audiences across the country,” said Dr. Melissa Karmen Lee, CEO of the Chinese Canadian Museum, in the announcement. “Curated by renowned researcher and historian Catherine Clement, the exhibition explores the period of the Chinese Exclusion Act (1923-1947) and its tragic consequences on an entire community, a history that not all Canadians are aware of, which is why it’s important for us to take this exhibition on the road and share it with the rest of the country.”
For more event details and background on the museum’s exhibitions, visit www.chinesecanadianmuseum.ca
This week
May is Skin Cancer Awareness Month
May is Haitian Heritage Month
May 1 is National Physician’s Day in Canada
Something to think about in the week ahead. . .
—Albert Camus, French philosopher (1913 – 1960)
Next week
In a presentation at the 2023 Skin Spectrum Summit, Dr. Monica Li (Vancouver) described how the sequelae of acne, rather than the condition itself, often drive patients with skin of colour to seek medical help. She also touched on how the side effects of treatment can lead to reduced treatment adherence among these patients.
Save the date for the Atopic Dermatitis Summit.
On May 11, 2024, from 10 a.m. to 1 p.m. EDT, Drs. Marissa Joseph and Neil Shear will co-chair the Atopic Dermatitis Summit, a one-day virtual medical education event seeking to provide the highest-quality AD education to help Canadian patients receive the best care possible. The session is developed by the organizers of Skin Spectrum Summit.
You can join your colleagues to learn more about the incidence of and the latest therapies for AD through live Q&As and lectures.
The Summit is a landmark opportunity to learn to:
Effectively communicate about AD with patient and their families
Diagnose AD across all skin phototypes
Prioritize sun protection in the management of AD
Address disparities among Indigenous communities
Understand the interplay between food allergies and AD
Registering for this compelling event is free, but space is limited. Reserve your (virtual) space now at https://tinyurl.com/ADSummit2024
L’Oréal, Procter & Gamble, Dermtek Pharma and other event supporters. Learn more at www.skinspectrum.ca/ad
If you like Skin Spectrum Weekly, why not check out Chronicle’s publications, podcasts, and portal?
Established in 1995, The Chronicle of Skin & Allergy is a scientific newspaper providing news and information on practical therapeutics and clinical progress in dermatologic medicine. The latest issue features:
Drs. Brittany Waller (Regina, Sask.), Charles Lynde (Markham, Ont.), Gurbir Dhadwal (Surrey, B.C.), and Ashley O’Toole (Scarborough, Ont.) discuss new interleukin-inhibitors and expanded indications for existing medications.
Dr. Iltefat Hamzavi (Detroit) presents a round-up of the current research on managing vitiligo.
Drs. Michael Stevens (Bedford, N.S.), Ilya Shoimer (Calgary), and Mark Lupin (Victoria) provide a round-up summary of the current science on managing basal cell carcinomas and touch on treatments in development.
Plus regular features, including the popular column “Vender on Psoriasis” by dermatologist Dr. Ron Vender.
Read a recent digital edition of The Chronicle of Skin & Allergy here. To apply for a complimentary* subscription or to receive a sample copy, please email health@chronicle.org with your contact information.
The Women in Dermatology e-newsletter updates readers with new findings concerning dermatologic issues affecting women and the female dermatologists who care for them. Read the current issue here.
Season three of the Vender on Psoriasis podcast with Dr. Ron Vender has begun. Listen to the new season here. In episode five, Dr. Vender discusses whether vitamin D influences psoriasis severity, sex differences in psoriatic inflammation itch, and the risk of psychiatric disorders associated with acitretin.
And if you’re looking for a web destination for all things derm, visit derm.city, “Where Dermatology Lives.” Please like, rate, review, and share it with your colleagues.