Post-inflammatory Hyperpigmentation

Modern possibilities of a supporting therapy and correction of post-inflammatory skin changes in patients with acne

Background. Acne has a net detrimental effect on the quality of life of patients, which is due not only to long-term treatment and predominance of dermatosis on the face, but also due to substantial risk of development of enduring post-inflammatory skin changes. The main part of treatment methods for post-acne marks is currently aimed at correction of already formed rash, and not at prevention of its development. In this respect, studies aimed at development of new methods for prevention and treatment of post-inflammatory skin changes in acne are particularly topical. Aim. To evaluate clinical efficiency and tolerability of Postacnetin gel at prevention and correction of significant post-inflammatory skin changes in patients with severe forms of acne vulgaris. Methods. 60 patients with severe forms of acne were under observation and were prescribed isotretinoin and topical medications in accordance with the Federal Guidelines of Treatment. Depending on the planned supporting therapy, the patients were divided into main and control groups of 30 people. Patients of the control group used only adapalene cream after the end of the course of systemic treatment with isotretinoin. Patients of the main group were additionally prescribed Postacnetin gel 2 months before reaching the cumulated dose of isotretinoin, and were also recommended to use it within 4 months after termination of isotretinoin therapy alongside with the use of adapalene cream. The effect of Postacnetin gel on post-inflammatory skin changes was assessed over time by counting post-acne elements, mexametry data and results of assessment of cicatrical changes according to the scale of G. Goodmann et al. Tolerability of the therapy was studied by means of monitoring of adverse reactions and calculation of the dermatology life quality index (DLQI). Results. By the end of application of the systemic medication, persistent erythema developed less often in patients of the main group, and pigmentation and scars were clinically less severe according to the data of the mexametry and the scale of G. Goodman et al. Subsequent dynamic observation of patients of the main group revealed more significant regression of post-inflammatory changes in them. Thus, dark spots were less common in these patients in the 2nd and 4th months in comparison with the control group, and according to mexametry data, they were less severe. They also had lower severity of scars and level of the total index of the quantitative scale of G. Goodman et al. According to the results of monitoring of side effects and DLQI, both treatment regimens were well tolerated. Conclusion. The use of Postacnetin gel in the complex therapy of patients with severe forms of acne vulgaris is an effective method for prevention and correction of persistent post-inflammatory skin changes and is well tolerated by patients.

Predicting the risk of postinflammatory hyperpigmentation: The palmar creases pigmentation scale

BACKGROUND

Postinflammatory hyperpigmentation (PIH) may affect any skin type but has been linked more often to darker skin. While propensity to hyperpigmentation has not been fully elucidated, there may be a direct correlation to one's palmar crease pigmentation.

OBJECTIVE

The aim of this study is to validate the reliable use of a palmar creases pigmentation (PCP) scale, and its accuracy in predicting the risk of PIH.

METHODS

A prospective, comparative, and blinded study was conducted through photo-numeric analysis of 126 photographs of pairs of palms. We utilized a 4-point visual scale based on the level of contrast between palmar crease pigment and that of the surrounding skin. Score 0 indicated no difference, score 1 referred to a low difference, score 2 meant a moderate difference, and score 3 related to a high difference. Scores were subdivided based on the risk of PIH. Scores 0-1 are low risk and scores 2-3 are high risk. A panel of 8 medical experts independently evaluated and re-evaluated the photographs that were shown in a random order.

RESULTS

A significant degree of inter-rater reliability was found at both evaluation visits, with an intra-class correlation coefficient (ICC) = 0.908, P <.001, at the first evaluation and an ICC = 0.924, P <.001, at the second evaluation, demonstrating a validity of the scale. Global Fleiss kappa for intra-rater reliability for all physicians was 0.514.

CONCLUSION

The PCP scale can be effectively used by any physician to predict hyperpigmentation risk.

Face and Neck Pigmentary Alterations in Hair Dye Users: A Cross-sectional Study from South India

Background:

Hair dyes are commonly used for the concealment of grey hair in India. The pigmentary alterations produced by hair dyes on the face and neck have not received sufficient attention.

Aims:

To study the pigmentary alterations on the face and neck in hair dye users, and identify possible risk factors associated with the face and neck hyperpigmentation.

Methods:

A hospital-based descriptive cross-sectional study was done on consecutive hair dye users. A detailed history was taken, and a clinical examination was done to record the pigmentary alterations. The patterns, areas affected, the intensity of hyperpigmentation, percentage of the area involved and risk factors were noted.

Results:

One hundred and twenty patients were included in the study. Around 118 (98.3%) patients had hyperpigmentation over face and/or neck: 16 (13.3%) barely perceivable, 40 (33.3%) mild, 44 (36.7%) moderate, and 18 (15%) severe pigmentation. The lateral forehead (106, 88.3%), the helix of the ear (106, 88.3%), central forehead (97, 80.8%), and zygomatic area (92, 76.7%) were the most frequently affected areas in our study. Fourteen patients (11.7%) had depigmented macules on the scalp and/or lips.

Conclusion:

Pigmentary alterations, particularly hyperpigmentation over the upper face and ears are common with the use of hair dyes. The skin type may play a role in the intensity of hyperpigmentation.