‘Breadth’ of options available for scarring, dyschromias in patients with skin of color
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Key takeaways:
- Combining oral therapies with topicals can be effective in Fitzpatrick skin types IV to VI.
- Sun protection, intermittent chemical peels or laser therapy may also be useful in hyperpigmentation.
A number of interventions and therapeutic combinations are available to treat scarring and dyschromias in individuals with Fitzpatrick skin type IV to VI, or “skin of color,” according to a study.
“Prior research has shown a significant increase in patients with [Fitzpatrick skin type (FPS)] IV to VI receiving dermatologic care for dyschromias, and we know that these patients are also more likely to have complications in wound healing, such as keloids,” Julien C. Bourgeois, BS, of Tulane University Medical School, told Healio. “As treatment protocols have only recently begun to focus on the management of pathology in patients of color, we wanted to highlight current and developing interventions specific to these patients.”
Bourgeois added that scarring and dyschromias are “challenging” to treat.
“Current protocols are not without complications and side effects that must be considered when offering therapy to patients with FPS IV to VI,” he said.
Some of these side effects include infection, edema, dehiscence, hematoma formation and tissue necrosis, according to the findings. Longer-term adverse outcomes of treatment may include scarring and scar widening, hypertrophic scars, keloids and pigmentary changes.
The current study was designed to be “incredibly comprehensive” but still specific to the needs of patients with FPS IV to VI, according to Bourgeois.
The group studied well-researched topicals, oral medications and supplements, injectables, lasers, procedures, systemic therapies and bandaging techniques.
“Therapies ranged from long-time gold standards to experimental and developing treatments, and we discussed both efficacy and possible complications specific to patients of color,” he said. “By doing so, this study provides physicians with a resource for informed decision-making while offering treatment considerations for multifaceted interventions.”
An example is to combine oral interventions such as melatonin and glutathione with topicals such as Kligman’s formula, retinols or niacinamide. Moreover, this combination may also include sun protection, intermittent chemical peels or laser therapy for the treatment of hyperpigmentation, according to Bourgeois.
“Certainly, these decisions are at the physician’s discretion with knowledge of risks, but increasing our arsenal for improving patient outcomes is of the utmost importance,” he said.
If there was a surprising result for Bourgeois, it was the breadth of options at the disposal of dermatologists who are treating scarring and dyschromias. That said, while there are options, more understanding of those options is critical.
“For example, varying kinds and depths of chemical peels need to be further studied in patients of color to ensure therapeutic doses without side effects,” he said. “The same can be said for lasers.”
With the current study, Bourgeois and colleagues hoped to provide a one-stop resource for clinicians treating this patient population.
“We hope that our results provide a strong baseline for the consideration of multiple therapy options in scarring and dyschromia,” he said. “It is necessary that physicians are familiar with these therapies and their side effects so that patients of color can be properly counseled on each treatment option and make an informed decision.”
Bourgeois acknowledged that many of the therapies they studied have efficacy in most or all skin types.
“However, patients with FPS IV to VI have unique considerations that must be addressed,” he said. “There is much excitement in the continued development of effective therapies for scarring and dyschromia, and now, we have the option to consider multiple well-researched options when treating patients.”
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