{"id":16213,"date":"2017-08-11T10:15:28","date_gmt":"2017-08-11T14:15:28","guid":{"rendered":"https:\/\/aerolase.com\/?p=16213"},"modified":"2017-08-11T10:15:28","modified_gmt":"2017-08-11T14:15:28","slug":"acne-associated-hyperpigmentation-important-consideration-patients-skin-color","status":"publish","type":"blog","link":"https:\/\/www.varshabi.com\/Aerolase\/blog\/acne-associated-hyperpigmentation-important-consideration-patients-skin-color\/","title":{"rendered":"Acne-Associated Hyperpigmentation an Important Consideration in Patients with Skin of Color"},"content":{"rendered":"<div class=\"article-header\">\n<div class=\"panel-pane pane-node-title\"><\/div>\n<div class=\"byline\"><a href=\"http:\/\/www.mdedge.com\/edermatologynews\/article\/144305\/acne\/acne-associated-hyperpigmentation-important-consideration\" target=\"_blank\" rel=\"noopener\"><span class=\"field-label\">By:&nbsp;<\/span>Kari Oakes&nbsp;&nbsp;Dermatology News<\/a><\/div>\n<div class=\"panel-pane pane-custom pane-2 social-media-list\">\n<div class=\"pane-content\">\n<div class=\"resp-sharing-button resp-sharing-button--print resp-sharing-button--small\"><\/div>\n<\/div>\n<\/div>\n<\/div>\n<div class=\"panel-pane pane-md-paged-body hidden-print\">\n<div class=\"pane-content\">\n<section class=\"field field-name-field-body field-type-text-long field-label-hidden main_body\">NEW YORK<span class=\"dateline\">&nbsp;<\/span>\u2013 When treating patients with skin of color for acne, treatment goals may vary from those of patients with lighter skin, according to Andrew F. Alexis, MD.<\/p>\n<aside class=\"offset-region offset-block offset-block__with-content panel-panel loaded\">\n<div class=\"panel-panel-inner\"><\/div>\n<\/aside>\n<p>For example, in patients with Fitzpatrick skin types V and VI, the desired treatment outcome is not only the resolution of acne but also the resolution of hyperpigmentation, said Dr. Alexis, chairman of the department of dermatology at Mount Sinai St. Luke\u2019s and Mount Sinai West, New York, N.Y.<\/p>\n<p>\u201cPostinflammatory hyperpigmentation is often the driving force for the dermatology consult\u201d in individuals with skin of color,&nbsp;<span class=\"Hyperlink\">Dr. Alexis<\/span>&nbsp;said at the summer meeting of the American Academy of Dermatology. \u201cThey may be just as concerned about their dark spots as underlying acne,\u201d he noted, citing a study that he coauthored (<span class=\"Hyperlink\">J Clin Aesthet Dermatol. 2014 Jul;7[7]:19-31<\/span>).<\/p>\n<p>In the study \u2013 a survey of patients with acne to determine which treatment outcomes were most important \u2013 41.6% of the nonwhite female patients reported that clearance of postinflammatory hyperpigmentation was the most important goal, compared with 8.4% of white female respondents (<em>P<\/em>&nbsp;less than .0001).<\/p>\n<p>As with so many conditions that require a prolonged course of treatment, setting expectations is a key part of the dermatologist\u2019s communication with the patient, Dr. Alexis continued. \u201cMake sure that they know that you are going to treat the dark spots,\u201d and that it will take time \u201cto get to the desired endpoint.\u201d<\/p>\n<p>It\u2019s important to avoid undertreating patients, especially darker-skinned patients, where ongoing subclinical inflammation may contribute to hyperpigmentation. Even in lesions that appear grossly noninflamed, biopsies may find histological evidence of inflammation, with increased T-cell infiltration of the pilosebaceous units, Dr. Alexis said.<\/p>\n<p>However, there\u2019s always a balancing act in determining how aggressively to treat patients, he added. Dermatologists have to be aware of the risk of hypertrophic scar formation in darker-skinned individuals, especially in truncal areas.<\/p>\n<p>When addressing acne, step one is to aggressively reduce acne-associated inflammation to reduce potential sequelae. This can be done with any of a number of agents, such as retinoids, benzoyl peroxide, dapsone, azelaic acid, and even intralesional corticosteroid injections, he said.<\/p>\n<p>\u201cAll agents have been considered in darker skin types,\u201d he said, noting that \u201cretinoids are particularly important because they can also treat postinflammatory hyperpigmentation.\u201d Tretinoin 0.1% cream and tazarotene 0.1% cream are both good choices, he added.<\/p>\n<p>Adapalene in a fixed combination with benzoyl peroxide has been studied in darker-skinned patients, with no difference in tolerability or higher incidence of pigmentary sequelae than in lighter-skinned patients, he pointed out.<\/p>\n<p>Dapsone 5% and 7.5% have also been studied in patients with darker skin, and both concentrations showed comparable results for safety and efficacy.<\/p>\n<p>The thinking about second-line agents can shift a bit when treating acne in darker skin. For example, azelaic acid as a 20% cream or 15% gel can be a good choice and can be helpful in treating postinflammatory hyperpigmentation, but azelaic acid is \u201cnot as good an antiacne agent as retinoids,\u201d Dr. Alexis said.<\/p>\n<p>Patients should understand that any of these choices are primarily acne-directed treatments, to be deployed over the first 3-6 months of treatment. Then, beginning at about the 3-month mark and continuing for up to a year, hyperpigmentation can be addressed. \u201cReally emphasize the duration of treatment,\u201d when treating hyperpigmentation, Dr. Alexis advised.<\/p>\n<p>Once the acne is under control and hyperpigmentation can be assessed on its own, dermatologists can consider whether bleaching agents are appropriate. \u201cShould they be used? If so, how?\u201d he asked.<\/p>\n<p>Bleaching agents can be effective, said Dr. Alexis, who recommends lesion-directed rather than broad-field therapy, unless there are many larger hyperpigmented macules. \u201cThe more common scenario is smaller, more distributed lesions,\u201d he said. \u201cSuperficial chemical peels, if used with caution, can be a good adjunct,\u201d to bleaching agents, he added.<\/p>\n<p>Coming down the road are topical nitric oxide preparations, which he said are looking good for darker skin in clinical trials.<\/p>\n<p>\u201cThe key to great outcomes is to initiate a combination regimen that targets inflammation and reduces hyperpigmentation,\u201d said Dr. Alexis. Then, he advised, minimize irritation but don\u2019t undertreat, consider adjunctive chemical peels, and above all, \u201cset realistic timeline expectations.\u201d<\/p>\n<\/section>\n<\/div>\n<\/div>\n","protected":false},"excerpt":{"rendered":"<p>By:&nbsp;Kari Oakes&nbsp;&nbsp;Dermatology News NEW YORK&nbsp;\u2013 When treating patients with skin of color for acne, treatment goals may vary from those of patients with lighter skin, according to Andrew F. Alexis, MD. For example, in patients with Fitzpatrick skin types V and VI, the desired treatment outcome is not only the resolution of acne but also [&hellip;]<\/p>\n","protected":false},"author":4,"featured_media":16216,"menu_order":0,"template":"","format":"standard","blog_category":[50],"blog_tag":[61,72,51],"class_list":["post-16213","blog","type-blog","status-publish","format-standard","has-post-thumbnail","hentry","blog_category-skin-health","blog_tag-acne","blog_tag-hyperpigmentation","blog_tag-skin-of-color"],"yoast_head":"<!-- This site is optimized with the Yoast SEO Premium plugin v22.7 (Yoast SEO v22.8) - https:\/\/yoast.com\/wordpress\/plugins\/seo\/ -->\n<title>Acne-Associated Hyperpigmentation an Important Consideration in Patients with Skin of Color &#8226; Aerolase<\/title>\n<meta name=\"description\" content=\"Hyperpigmentation is often a residual side affect from acne. 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