Treating Hyperpigmentation in Darker-Skinned Patients

May 2013 | Volume 12 | Issue 5 | Original Article | 563 | Copyright © May 2013


Nazanin Saedi MDa and Anand K. Ganesan MDb

aDepartment of Dermatology and Cutaneous Biology, Thomas Jefferson University Hospitals, Philadelphia, PA
bDepartment of Dermatology, University of California, Irvine, Irvine, CA

Abstract
BACKGROUND: The treatment of hyperpigmentation in darker-skinned patients (Fitzpatrick skin phototypes III-VI) has remained challenging for dermatologists. No studies have been conducted on hyperpigmentation under the eyes, axilla, and neck in darker-skinned patients. This survey was designed to assess current treatments of hyperpigmentation in these areas.
MATERIALS/METHODS: With approval from the institutional review board at the University of California, Irvine, an electronic survey was sent to practicing dermatologists that contained 18 questions regarding the approach to evaluating and treating hyperpigmentation under the eyes, in the axilla, and along the neck.
RESULTS: Fifty dermatologists completed the survey, and 46 (92%) reported treating patients with darker skin. The ethnic groups treated were Latino (97.8%), African American (97.8%), Middle Eastern (77.6%), and Asian (88.9%). Thirty-six reported treating patients with hyperpigmentation under the eyes, and 22 (61.1%) thought the hyperpigmentation was a result of idiopathic increase in melanin deposition. Forty-two responded to treating hyperpigmentation in the axilla, most of whom thought it was related to acanthosis nigricans (69.0%) or contact dermatitis (59.5%). Forty responded to treating hyperpigmentation on the neck, most of whom treated the condition with hydroquinone (66%). Treatments for these 3 areas were not found to be effective.
CONCLUSIONS: Hyperpigmentation under the eyes, under the arms, or on the neck is a significant problem in darker-skinned patients that is refractory to currently available treatments, highlighting the necessity of developing treatment approaches directed toward this population. Two cases of hyperpigmentation on the neck are presented, describing a new entity that primarily affects dark-skinned individuals.

J Drugs Dermatol. 2013;12(5):563-567.

INTRODUCTION

There is an increased frequency of disorders characterized by hyperpigmentation in darker racial ethnic groups (Fitzpatrick skin phototypes III-VI), and the treatment of hyperpigmentation in these patients has remained challenging for dermatologists.1 The melanocytes of darker-skinned individuals show an exaggerated response to cutaneous injury.1 Following cutaneous trauma or inflammation, melanocytes can react with the production of normal, increased, or decreased melanin.1 Although the precise pathogenesis is unknown, it is thought that hyperpigmentation results from cytokines, inflammatory mediators, and reactive oxygen species.1
The etiology of hyperpigmentation in specific regions is neither well understood nor well treated. We identified specific areas that need further evaluation, including the region under the eyes, in the axilla, and along the neck. To date, no studies have been conducted on hyperpigmentation in these regions, and we commonly see these conditions in our clinic. This survey was designed to assess current treatments among practicing dermatologists in the treatment of hyperpigmentation in dark-skinned patients under the eyes, in the axilla, and along the neck.

MATERIALS AND METHODS

With approval from the Institutional Review Board at University of California, Irvine (UC Irvine), an electronic survey was sent to practicing dermatologists from September 2009 through September 2010. The survey was initially sent to the dermatologists associated with UC Irvine, and it was then sent to members of the Association of Professors in Dermatology (APD) and selected pigmentary disorder experts nationally and internationally. The survey contained 18 questions regarding the approach to evaluating and treating hyperpigmentation under the eyes, in the axilla, and along the neck and whether the dermatologist has treated darker-skinned patients with hyperpigmention, which ethnic groups he/she has treated, how the physician assesses the depth of pigmentation, and which of the areas have been treated. For treating hyperpigmentation under the eyes, in the axilla, and along the neck, the dermatologists were asked about the proposed etiology of the hyperpigmentation, the treatments used, and the efficacy of treatment. For each region treated, there was also a question pertaining to which laser and light devices were used, including quality (Q)-switched lasers, fractional laser devices, ablative lasers, and intense pulsed light (IPL). If a laser or a light device was used, the physician was also asked about the efficacy (<25% effective, 25% to 50% effective, 51% to 75% effective, or >75% effective).

RESULTS

The response rate for the survey was 10% (50 responses). Fifty dermatologists completed the survey, 46 (92%) of whom reported treating patients with darker skin. The ethnic groups treated were Latino (97.8%), African American (97.8%), Middle Eastern (77.6%), and Asian (88.9%). The depth of pigment deposition was assessed by clinical examination findings (95.7%), Wood’s
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