Combination therapy was among the top 10 medications in the overall group seen by dermatologists, as well as in the white and black and Asian groups (Table 2-5). While combination
therapy was overall remarkably low in both genders, females were 10 times more likely to receive combination therapy than males (P=0.002). There was no statistically significant
difference in combination therapy between those who identified themselves as African Americans and non-African Americans (P=0.73) and those who identified themselves as Hispanic and non-Hispanic individuals (P=0.44). Both African Americans and Hispanics are less likely to have a procedure performed in the office. African Americans were almost three times less likely to receive a procedure for dyschromia (14%) compared with non-African Americans (36%) (P=0.0007). 17% of Hispanics received a procedure for dyschromia compared with 35% of non-Hispanic individuals (P=0.007). In Asians, 27% received combination treatment compared to 6% of non-Asian counterparts (P=0.004).
DISCUSSION
As the number of ethnic persons in the US continues to grow, dyschromia may become a more common diagnosis in patients with darker skin types. Dyschromia is the fifth most common diagnosis in African Americans and the tenth leading diagnosis in Hispanic patients seen by dermatologists.1 Hyperpigmentation is also a common concern among the Asian/Pacific Islander/Native Hawaiian population.8 Asians had 3,800 visits per 100,000, which was the highest among the races. Perhaps this is because melasma is common in Fitzpatrick skin type 4-6 and is also special concern among Asians.5,9 The average age of patients seen for dyschromia is increasing over time, consistent with the general trend of increasing median age in the US population. People 55-64 years old made the most dyschromia visits per 100,000 population, and the median age of the US population according to the US Census Bureau is over 40 years old.10
Treatment for hyper or hypopigmentation is individualized for certain skin types. Thus proper diagnosis and treatment is important for a successful outcome, and expert recommendation from a dermatologist is needed. Various methods for treatment include topical corticosteroid agents, tretinoin, hydroquinone, chemical peels, and a wide array of lasers.11,12 Prevention of hyperpigmentation, eg, post-inflammatory hyperpigmentation, in darker skin types is crucial.13,14 Persons of color are more prone to post inflammatory hyperpigmentation from trauma, acne, or inflammatory disorders, such as pseudofolliculitis barbae.15 There are various topical agents to treat and prevent hyperpigmentation, including more novel ingredients such as soy extracts, kojic acid, licorice, mulberry, rucinol, niacinamide, arbutinin, resveratrol, and dioic acid.16 The tendency for darker skin to develop certain hyperpigmented disorders is high compared to Caucasians, thus treatment may differ in individuals with darker skin.17 For example, in darker skin, topical retinoids are typically the first line treatment for acne for prevention of its associated post-inflammatory hyperpigmentation.15 African Americans and Hispanics were both less likely to have a procedure performed in the office. Procedures such as cryotherapy, electrodessication and curettage, or chemical peels may be avoided because of the risk of hypopigmentation and scarring. Chemical peels in darker skinned individuals must be performed with caution, as darker skin persons may have unpredictable reaction to the chemicals.18 Laser must also be performed with caution in darker skin types for risk of dyspigmentation, texture changes, epidermal blistering, and scarring.19 Although there are various laser treatment options for darker skin individuals, the potential for these adverse effects may account for a reason why African Americans and Hispanics are less likely to have a procedure performed for dyschromias.20
The use of sunscreen is a vital component of therapy for hyperpigmentation
in all skin types. It is well known that UV
