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Treatment of Post-Inflammatory Hyperpigmentation in Patients With Skin of Colour
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- This review of data from 46 studies on post-inflammatory hyperpigmentation in 1356 patients with skin of colour found that topical retinoids and laser therapy were the most commonly used treatment modalities, with partial improvement noted in 85% and 66% of the participants using these modalities, respectively. Laser therapy resulted in a complete resolution in 26% of the patients. Other treatment modalities including hydroquinone, intense pulsed light, high-intensity focused ultrasound, and chemical peels showed varying degrees of partial improvement.
- This study highlights the challenge of treating post-inflammatory hyperpigmentation in patients with skin of colour. Topical retinoids and laser therapy are currently the most effective treatments, with laser therapy being the only therapy offering potential complete resolution.
abstract
This abstract is available on the publisher's site.
Access this abstract nowPost inflammatory hyperpigmentation (PIH) affects all skin types with a heightened predilection for darker skin tones. Its course is chronic once developed and treatment is often difficult. This systematic review aims to summarize the treatment outcomes for PIH with a focus on skin of colour (SOC) individuals. A literature search was conducted using MEDLINE (from 1946), Embase (from 1974), PubMed, and Cochrane in adherence to the Preferred Reporting Items for Systematic Reviews and Meta-Analysis guideline. Results from 48 studies summarized 1356 SOC individuals. The mean age was 29 years (n = 1036) and 78% were female (n = 786). The ethnic prevalence was 70% Black, 27% Asian, and 3% Latin. Overall, 20% were Fitzpatrick skin type (FST) III, 40% FST IV, 34% FST V, and 6% FST VI. Most cases were precipitated by inflammatory conditions (89%) and localized to the face (83%). The most frequently reported interventions were topical retinoids (22%) and laser therapy (17%). Partial improvement was seen in 85% and 66% of participants, respectively. Laser was the only intervention that offered complete resolution in a subgroup of patients (26%); however, there were reported cases of PIH exacerbation following treatment. Chemical peels (9%) and hydroquinone (7%) were among other treatments with less effective outcomes. PIH and its persistence is a prevalent issue, significantly affecting many affected individuals with darker skin tones. Our results show a lack of robust efficacy across all treatment modalities. There is considerable room for improvement in interventions for at-risk populations.
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Treatment of Post-Inflammatory Hyperpigmentation in Skin of Colour: A Systematic Review
J Cutan Med Surg 2024 Jul 29;[EPub Ahead of Print], K Mar, B Khalid, M Maazi, R Ahmed, OJE Wang, T Khosravi-HafshejaniFrom MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine.
Post-inflammatory hyperpigmentation (PIH) commonly affects darker skin types and occurs after cutaneous inflammation or injury. This systematic review by Mar et al summarizes the current knowledge on treating PIH in patients with skin of color. The authors performed an extensive literature review on the outcomes of PIH treatment in patients with skin of color, ultimately including 48 studies with 1356 individuals. Topical retinoids and laser therapy were the most frequently reported interventions. An overall lack of robust efficacy of the modalities reviewed was noted, with only topical retinoids, laser therapies, and Thiamidol providing significant improvements compared with no treatment. Other treatments that provided some, but less significant, benefit included topical hydroquinone (2% and 4%), combination treatments, bakuchiol, and chemical peels.
The studies reviewed highlighted multiple treatment options that helped reduce PIH; however, a minority were successful in completely treating PIH. As such, we recommend caution when performing procedures that may lead to PIH and instituting preventive measures when appropriate. In addition, the use of a multimodal approach combining strict photoprotection, topical agents, and procedural options may have greater efficacy than the use of solitary agents in the management of PIH.
While nicely summarizing current treatment practices, this review also highlights the need for standardized methodologies in PIH evaluation to improve clinical data and comparison across studies. The need for more effective PIH treatments in populations with skin of color is another key takeaway. More inclusive and rigorous studies investigating novel therapeutics are necessary to address the unique challenges faced by individuals with skin of color, ensuring that they receive the best care possible.