WATCH VIDEO ABSTRACT: Scarring and Dyschromias in Fitzpatrick Skin Type IV-VI: A Review of Dermatologic Treatment Protocols

As with much of dermatology, most research on wound healing has been based on afflictions in light skin, resulting in a dearth of evidence-based protocols on the management of wound healing disorders and complications of healing more common in FPS IV-VI or skin of color (SOC). Wound healing in patients with SOC is more likely to be complicated by dyschromia (hyperpigmentation and hypopigmentation) and the formation of hypertrophic scars and keloids.^1-3 Dyschromias may be caused by injury to the skin, or they may be post-inflammatory, secondary to dermatitis, infection, UV exposure, or drug reactions, among others.^3,4 Hypertrophic scarring and keloids are often secondary to injury, surgical procedures, or other therapies.^5,6 Disordered wound healing has been extensively studied in the literature.^7-11 Still, given the relative incidence of pathologic wound healing complications in SOC, physicians must be prepared to counsel all patients on the possibility of disordered healing as well as the treatments for these complications. It is important to note that many of these interventions come with their own side effects that must be included in patient education and shared decision-making.

Dermatologic Complications of Wound Healing in Skin of Color
While disorders and complications of wound healing in SOC patients can take many forms, many cases tend to take on two different dermatologic pathologies: scarring and dyschromia.¹ Wound hypertrophy, keloid, or scarring may develop as complications of overactive cellular mechanisms in wound healing.^12,13 Dyschromias in wound healing are secondary to the effects of inflammation on melanocytes or deposition of exogenous substances.¹⁴ In both hyperpigmented and hypopigmented wounds, disordered production, transport, or distribution of melanin causes observed pigmentation changes.¹⁵