Facial hyperpigmentation: causes and treatment

Abstract

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.

Facial hyperpigmentations and their management

“…Fizik muayenede çeşitli boyutlarda hiperpigmente maküller ve yamalar dağınık olarak yerleşir (18) (Resim 2).…”

“…Tanı genellikle klinik olarak konsa da tanı konmakta güçlükle karşılaşılan olgularda biyopsi uygulanabilir (18) . Histolojik olarak üst dermiste ve perivasküler alanda serbest ya da melanofajlar içinde melanin depolanması gözlenir (20) .…”

Treatment of Hyperpigmentation in Darker Skins

“…A list of skin lightening agents are listed in Table 1 [2]. The largest group in those agents is tyrosinase inhibitors, and the most wellknown agent is hydoquinone which is often considered as "topical gold standart" in the melasma and hyperpigmentation treatments [4].…”

“…Darker skin types are characterized by higher content of melanin, higher eumelanin to pheomelanin ratio. This is an advantage for protection against ultraviolet (UV) radiation, however it also makes darker skin more vulnerable to postinflammatory dyspigmentation [1,2].…”

Melasma, Novel Treatment Modalities

“…Kojic acid is used in 1-4% concentrations, usually in combination with other agents [25,26]. It is a known sensitizer and has been claimed to be mutagenic [17].…”