Even routine medical dermatology procedures can induce pigmentary alterations in darker skin tones, notes Dr. Andrew Alexis, co-chair of Skin of Color Update, and vice-chair for diversity and inclusion for the Weill Cornell Medical College Department of Dermatology. In an interview with Next Steps in Derm, in partnership with Pigmentary Disorders Exchange Symposium, Dr. Alexis outlines how skin color and skin type matter in procedural treatments. Watch as Dr. Alexis shares his approach in determining a patient’s risk of hypopigmentation and hyperpigmentation. Learn what questions to ask patients and how a glance at the palm of a patient’s hand may aid in your risk assessment.
Further Reading
If you want to read more about procedural treatments in darker skin tones, check out the following articles published in the Journal of Drugs in Dermatology:
ABSTRACT
Hyperpigmentation, uneven skin tone, textural changes, and dull skin are common cosmetic concerns in skin of color. Other signs of aging, including fine lines, deeper wrinkles, and skin laxity, also occur but may present in later decades. In-office procedures such as laser treatments, energy devices, toxins, fillers, and chemical peels are useful options for addressing the most common cosmetic concerns in skin of color patients. Skincare can play an important role in improving cosmetic outcomes when used in conjunction with in-office procedures. With the availability of these approaches, clinicians can now integrate in-office procedures with skincare strategies to offer patients with skin of color a comprehensive treatment plan that meets their needs.
Postinflammatory Hyperpigmentation Following Mohs Micrographic Surgery: An Observational Study
ABSTRACT
Importance: Functional and cosmetic outcomes following Mohs micrographic surgery (MMS) are poorly studied in individuals with skin of color (SOC). Postinflammatory hyperpigmentation (PIH) may be long-lasting and highly distressing. SOC individuals are particularly susceptible to PIH following procedures.
Objective: To characterize factors that contribute to the development of PIH following MMS in SOC.
Design: This retrospective study included 72 SOC individuals with 83 cases of keratinocyte carcinoma treated with MMS between August 2020 and August 2021 at a single medical center in the Bronx, New York.
Results: Postinflammatory hyperpigmentation following Mohs micrographic surgery was more common in Fitzpatrick skin types (FST) IV to V (48.0%) compared to FST I to III (18.2%; P=0.006). Grafts and granulation resulted in higher rates of PIH compared to linear repairs and flaps (87.5% vs 30.7%; P=0.003). Cases with postoperative complications resulted in higher rates of PIH compared to cases without (81.8% vs 29.2%; P=0.001). In a subset analysis of linear repairs, polyglactin 910 as a subcutaneous suture produced a higher rate of PIH compared to poliglecaprone 25 (46.2% vs 7.1%; P=0.015).
Conclusions and Relevance: Individuals with SOC (FST IV to V) are more likely to develop PIH following MMS. Grafts and granulation lead to PIH more often than linear repairs and flaps. Postoperative complications significantly increase the risk of PIH. Surgeons should consider these risk factors during surgical planning in an effort to mitigate PIH in SOC individuals. Studies with larger sample sizes are indicated.
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