SummaryBy midcentury, the U.S.A. will be more ethnically and racially diverse. Skin of colour will soon constitute nearly one-half of the U.S. population, and a full understanding of skin conditions that affect this group is of great importance. Structural and functional differences in the skin, as well as the influence of cultural practices, produce variances in skin disease and presentation based on skin type. In the skin of colour population, dyschromia is a growing concern, and a top chief complaint when patients present to the physician. A thorough understanding of the aetiology and management strategies of facial hyperpigmentation is of importance in caring for those afflicted and also in the development of new therapies.What's already known about this topic?• In the skin of colour population, facial hyperpigmentation is a common and growing concern when presenting to the physician.• Facial hyperpigmentation can cause significant cosmetic disfigurement with subsequent emotional impact. Therapy continues to be challenging as there is no universally effective treatment. Existing agents have varying degrees of efficacy and potential risk of postinflammatory hyperpigmentation with different treatment protocols.What does this study add?• Persons of colour will soon comprise a majority of the international and domestic populations.• A comprehensive knowledge and approach to assessment and treatment is necessary to care properly for skin of colour patients.• This review thoroughly discusses aetiologies of facial hyperpigmentation and categorizes appropriate treatment strategies.Skin of colour, also known as ethnic skin, constitutes a wide range of racial and ethnic groups traditionally referring to persons of African, Asian, Native American, Middle Eastern and Hispanic backgrounds. By 2050, nearly one-half of the U.S. population will be nonwhite.1 These skin types are generally categorized as Fitzpatrick types IV-VI, and are more richly pigmented. Structural and functional differences in the skin, as well as the influence of cultural practices, produce variances in skin disease, presentation and treatment based on skin type. Darker skin phenotypes are characterized by higher content of melanin, higher eumelanin to pheomelanin ratio, and more effective distribution of melanin for protection against ultraviolet (UV) radiation. 2In skin of colour, the amount and epidermal distribution of melanin is an important biological feature.

There are an increasing number and variety of dermatologic surgical procedures performed safely in the office setting. This evidence-based guideline addresses important clinical questions that arise regarding the use and safety of local anesthesia for dermatologic office-based procedures. In addition to recommendations for dermatologists, this guideline also takes into account patient preferences while optimizing their safety and quality of care. The clinical recommendations presented here are based on the best evidence available as well as expert opinion.

We live in an era of edited selfies and ever-evolving standards of beauty. The advent and popularity of image-based social media have put Photoshop and filters in everyone's arsenal. A few swipes on Snapchat can give your selfie a crown of flowers or puppy ears. A little adjusting on Facetune can smoothen out skin, and make teeth look whiter and eyes and lips bigger. A quick share on Instagram, and the likes and comments start rolling in. These filters and edits have become the norm, altering people's perception of beauty worldwide.Earlier, photo-editing technology was widely available only for celebrities. Models and actors were made to look perfect in magazines and ads, but the general public did not have easy access to methods to alter their own appearance. They instead were left to idolize the standard of beauty present in the media, although most were aware of the editing and alterations that went into making celebrities look flawless. 1 Today, with apps like Snapchat and Facetune, that same level of perfection is accessible to everyone. Now, it is not just celebrities propagating beauty standards: it is a classmate, a coworker, or a friend. The pervasiveness of these filtered images can take a toll on one's self esteem, make one feel inadequate for not looking a certain way in the real world, and may even act as a trigger and lead to body dysmorphic disorder (BDD).Body dysmorphic disorder is an excessive preoccupation with a perceived flaw in appearance, classified on the obsessive-compulsive spectrum. 2 The disorder is more than an insecurity or a lack of confidence. Those with BDD often go to great lengths to hide their imperfections, engage in repetitive behaviors like skin picking or grooming, and may visit dermatologists or plastic surgeons frequently, hoping to change their appearance. A recent study 3 analyzed the effect of edited selfies on body dissatisfaction among adolescent girls and found that those who manipulated their photos more reported a higher level of concern with their bodies and an overestimation of body shape and weight. The study also suggested that those with a dysmorphic body image may seek out social media as a means of validating their attractiveness. Finally, those with a higher level of engagement on social media-including those actively trying to present a specific image of oneself or analyzing and commenting on other's photos-may have a higher level of body dissatisfaction. 3 The desire for cosmetic surgery is an important component of BDD. It is known that the angle and close distance at which selfies are taken may distort facial dimensions and lead to dissatisfaction. 4 Patients VIEWPOINT

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