Clinicians gain ground in treating pigmentation changes in skin of color

Key Points

National report - Patients with skin of color cope with a number of skin concerns, but treatment advances are helping dermatologists treat these patients effectively. Pigmentation changes are a major concern for these patients, experts say.

As a result, their skin can become increasingly pigmented in unwanted places. "That pigmentation is less welcome in their cultures than in Caucasian or lighter-skinned individuals," he says.

"In general, when someone comes in to see me for acne, regardless of whether or not they have skin of color, if they have a lot of cystic lesions, I prescribe an oral agent to target the acne right away," she says.

For patients with acne and melasma, Dr. Schlessinger prescribes oral amoxicillin or erythromycin, rather than minocycline or its derivatives, which can result in pigmentary changes. "At the same time, I generally place them on hydroquinone or an alternative to hydroquinone," he says.

For patients who want a quicker fix, Dr. Sarkar says she may also use a salicylic acid peel for the acne, which will not treat hyperpigmentation. She says she prefers the Vitalize Peel with a retinoic acid booster to treat hyperpigmentation.

In treating pigmentary changes, Dr. Schlessinger says laser treatments tend to be ineffective in patients with Fitzpatrick skin types IV, V and VI. As a result, he opts for topical treatments such as hydroquinone or other alternatives in treating postinflammatory hyperpigmentation or melasma.

Both Drs. Sarkar and Schlessinger say they have found hydroquinone and some alternatives most effective.

"Obagi Nu-Derm tends to be the most effective in my hands because it combines the benefits of hydroquinone along with a form of tretinoin in a framework that is acceptable to most patients," Dr. Schlessinger says.