Skin of Color

Physician-strength chemical peels are consistently the third most common cosmetic procedure next to neurotoxin and soft-tissue filler injections.¹ Superficial chemical peels are common and safe peeling procedures.² Facial chemical peels are highly sought after by aging patients who desire improvements to fine lines and wrinkles, pigmentation, clarity, and laxity, as well as patients with acne, hyperpigmentation, or melasma.

As a complementary procedure to hydroquinone homecare products, patients have used chemical peels to improve hyperpigmentation or melasma.³ While chemical peels are considered safe for all skin types, post-inflammatory hyperpigmentation can be a concern of higher strength chemical peels, particularly in those with darker skin.²

Retinol is a proven ingredient for the management of acne and is used as adjunctive care for photodamage due to its ability to enhance exfoliation, increase epidermal thickness, and reduce matrix metalloproteinase (MMP) activity (collagenase) while increasing collagen.^4-7

Studies have demonstrated that topical prescription retinoids are safe and effective in patients with dark skin for the treatment of post-inflammatory hyperpigmentation.⁸ Cosmetic retinol products have been shown to affect hyperpigmentation and provide a more even skin tone.⁵

An advanced, physician-strength superficial peel containing 3% retinol was developed to exfoliate and improve the appearance of fine lines and wrinkles, plump and firm skin, and reduce hyperpigmentation while promoting a bright, even complexion.

Formulated with bisabolol to help calm the skin, and Vitamin E as an antioxidant, this peel provides additional benefits to overall skin appearance with the addition of triethyl citrate and acetyl tyrosinamide to enhance the skin’s matrix for plumping and firming effects.^9-11

A single center, prospective clinical study evaluated the tolerability and effectiveness of a series of cosmetic retinol peels, in conjunction with a homecare regimen, to improve the appearance of fine lines, wrinkles, skin firmness, and overall complexion brightness on subjects with mild to moderate photodamage across a range of peel candidates, including those with moderate acne, hyperpigmentation or melasma, and skin of color.

Post inflammatory hyperpigmentation (PIH) is an acquired hyper-melanosis typically arising following inflammatory lesions. It is one of the most common dermatologic complaints, which may develop in all skin types, however, higher prevalence is seen in patients with Fitzpatrick skin types IV-VI.

The etiology underlying PIH can either be an exogenous source (allergy, irritation, contact dermatitis, dermabrasion, laser therapy or burns), an endogenous factor (primary inflammatory or bullous dermatosis) or even induced by an infectious agent such as herpes zoster virus infection. Morphologic pattern and degree of pigmentation vary depending on causative factors and melanin distribution in the epidermis, dermis or both.1,2,3

IH typically manifests as macules or patches in the same distribution in previous areas of inflammation, which can be classified as two clinical forms: epidermal and/or dermal. In epidermal PIH, melanocytes are activated, and release melanin resulting in tan brown or dark brown appearance and may take months to years to resolve. Dermal PIH includes activation of basal keratinocytes, which also release melanin, and present as dark brown to blue-grey discoloration that may either be permanent or resolve over an extended period of time if not treated.

Differentiating between the two is difficult, and PIH is probably a result of the combination of both epidermal and dermal lesions.⁴ The degree of PIH varies depending on the etiological factors, skin type or “chromatic tendency” as well as exposure to UV light, certain medications and cutaneous injuries (trauma or even shaving).^1,2,5,6 The discoloration is determined by the distribution and depth of pigment within the skin layers.

The pathogenesis of PIH is often related to an increase in melanin synthesis and/or irregular pigment dispersion resulting from cutaneous inflammation. It is considered the end result of: melanocyte proliferation, melanin synthesis and increased activation of tyrosinase coupled with transfer of melanosomes to neighboring keratinocytes. Although the exact mechanism is not yet fully understood, the rise in melanocyte activity and proliferation has been known to be stimulated by inflammatory mediators such as reactive oxygen species, prostaglandins and leukotrienes.^1,5

Axillary hyperpigmentation is a frequent dermatological complaint, characterized by dermal and epidermal PIH mainly associated with women of darker skin types. Etiological theory associates axillary hyperpigmentation of a form of post inflammatory hyperpigmentation due to continuous irritation due to hair removal, cleansing, tight cloths, or innate darkening from genetic related factors.¹¹

The purpose of this case study was to evaluate the efficacy of a 1064nm nanosecond QS Nd:YAG laser in the treatment of axillary PIH in Filipino women with Fitzpatrick skin types IV-V.