Hyperpigmentation & Scarring

NEWS/ QUIZ

2 MIN QUIZ

A 24-year-old African American woman presents to her dermatologist with hyperpigmentation for the past year, which has led to scarring. Because she has been wearing a mask since the start of the COVID-19 pandemic, she has developed worsening facial blemishes. When she was younger, she suffered from some acne, but this time, no matter what she tries, her skin has not evened out and is discolored everywhere. Additionally, she has been picking at the numerous blemishes on her face. Her normal skin routine is salicylic acid cleanser with a sunscreen moisturizer applied once daily. She is concerned about the constant scarring and needs assistance in properly diagnosing her skin condition and finding a regimen that can help with the pigmentation.

What is the diagnosis?

Select the correct answer

A) Melasma

B) Acne vulgaris

C) Dermatosis papulosa nigra

D) Pseudofolliculitis barbae

CORRECT

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INCORRECT

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Answer is: B

Acne is one of the most common dermatology issues among all races/ethnicities and both sexes.^1-3It is highly prevalent in Black/African American individuals, occurring in about 37% of women in this population.¹Acne vulgaris on the face is considered a multifactorial disease with respect to its pathophysiology and its impact on daily life.¹It is also known to cause substantial burden, including depression.^1,3 There are many factors, including hormones, genetics, cosmetics, diet, stress, and drug use, that could alter the state of this condition and are associated with substantial burden and impairments in health-related quality of life.¹

Skin color is normally not an important factor of skin disease progression; however, in dermatology, it affects the presentation and management of acne vulgaris because of the heightened risk of acne scarring in patients with darker skin types.⁴Additionally, skin color is not specific to a racial group, so people of all backgrounds can experience this outcome.⁵ The biology of pigmentation processes such as postinflammatory hyperpigmentation (PIH) is similar in populations with distinct genetic backgrounds.⁵ Epidemiology and treatment options vary in darker complexions, along with acne presentations.⁴ This could be due to elevated risk of PIH, keloid scarring, variations in tolerance to topical medication, and metabolic response to systemic isotretinoin.⁴More frequent clinical features encountered in people of color include dyspigmentation and scarring.⁴

PIH is the most common complaint among women of color with acne.^1,4 Epidermal lesions may persist for up to one year, and dermal pigmentation can persist for years.⁴ Also, distinctive subtypes of acne can occur, such as pomade acne, which presents as closed comedones and papules along the frontal hairline; acne cosmetica, caused by use of certain cosmetic products; and steroid acne due to certain skin-lightening agents.⁴

The treatment of acne for people of color is similar to that for Caucasian patients.^1,4 The main difference is understanding the potential sequelae of acne along with the importance of early diagnosis/treatment.⁴

As with all acne patients, the first step is to determine the predominant type of acne lesion and obtain a history of the patient’s skin type (normal, oily, dry, or combination).⁴

References:

1. Callender VD, Alexis AF, Daniels SR, et al. Racial differences in clinical characteristics, perceptions and behaviors, and psychosocial impact of adult female acne. J Clin Aesthet Dermatol. 2014;7(7):19-31.

2. Henderson MD, Abboud J, Cogan CM, et al. Skin-of-color epidemiology: a report of the most common skin conditions by race. Pediatr Dermatol. 2012;29(5):584-589. doi:10.1111/j.1525-1470.2012.01775.x

3. Barbieri JS, Shin DB, Wang S, Margolis DJ, Takeshita J. Association of race/ethnicity and sex with differences in health care use and treatment for acne. JAMA Dermatol. 2020;156(3):312–319. doi:10.1001/jamadermatol.2019.4818

4. Lawson CN, Hollinger J, Sethi S, et al. Updates in the understanding and treatments of skin & hair disorders in women of color. Int J Womens Dermatol. 2017;3(1)(suppl):S21-S37. doi:10.1016/j.ijwd.2017.02.006

5. Torres V, Herane MI, Costa A, Martin JP, Troielli P. Refining the ideas of “ethnic” skin. An Bras Dermatol. 2017;92(2):221-225. doi:10.1590/abd1806-4841.20174846

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