Abstract

Background Treatment of postinflammatory hyperpigmentation (PIH) in patients with dark skin is challenging as the treatment itself might provoke paradoxical PIH. Only few studies examined the safety and efficacy of nonablative laser treatment in these patients. The objective was to examine efficacy and safety of nonablative 1927 nm wavelength laser followed by bleaching creams in the treatment of PIH. Methods It was a prospective interventional pilot study that was conducted during 2019. All patients were of Fitzpatrick skin type IV who had unsatisfactory response to topical bleaching creams used for at least three months. Patients received one to four sessions of laser treatment (6 weeks apart) followed by topical hydroquinone 4% cream twice daily for 6 weeks. Improvement was assessed by two blinded independent dermatologist evaluators. Results A total of nine patients were enrolled and the outcome could not be assessed in one patient who was lost for follow-up. The affected sites were the abdomen, face, and other body parts. Three of the eight evaluated patients had excellent response (37.5%), four had satisfactory response (50.0%), and one had nonsatisfactory response (12.5%). The downtime was manifested as edema and erythema that disappeared after 5 to 7 days. Improvement was more evident in first session and it declined in subsequent sessions. None of the patients had paradoxical pigmentation after treatment. Conclusions Low energy low density nonablative fractional 1927 nm wavelength laser treatment followed by topical hydroquinone 4% cream for 6 weeks is a safe and effective modality for improving PIH in patients with darker skin types.

Highlights

  • Postinflammatory hyperpigmentation (PIH) is an acquired pigmentary disorder characterized by reactive hypermelanosis of the skin secondary to various endogenous and exogenous conditions [1]

  • It occurs following a number of dermatologic procedures such as laser treatment and chemical peeling [3, 4]. e intensity of postinflammatory hyperpigmentation (PIH) is probably determined by the inherent skin color and degree and depth of inflammation [4]. e course of the disease is chronic with irregularly shaped lesions that vary in color from lightbrown to bluish-grey [2]

  • Only few studies examined the safety and efficacy of laser treatment in skin of color [13, 14]. e efficacy and safety data of nonablative fractional laser in Saudi patients is limited [15, 16] with no data that focus on new technologies such as 1550 nm/1927 nm dual wavelength laser. e objective of the current study was to examine efficacy and safety of nonablative 1927 nm wavelength laser followed by a depigmenting cream in the treatment of Saudi patients with PIH

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Summary

Introduction

Postinflammatory hyperpigmentation (PIH) is an acquired pigmentary disorder characterized by reactive hypermelanosis of the skin secondary to various endogenous and exogenous conditions [1]. PIH affects all ages and affects both genders [3] It is frequently seen among dark-skinned racial/ethnic groups such as those with African, Asian, and South American ancestry [3]. PIH can develop after skin infections (such as impetigo, chickenpox, and herpes zoster), drug reactions, sunburn, trauma, and friction [3, 4] It occurs following a number of dermatologic procedures such as laser treatment and chemical peeling [3, 4]. Low energy low density nonablative fractional 1927 nm wavelength laser treatment followed by topical hydroquinone 4% cream for 6 weeks is a safe and effective modality for improving PIH in patients with darker skin types

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