Darker Skin Types Research Articles

Rickets.

Rickets is a bone disease associated with abnormal serum calcium and phosphate levels. The clinical presentation is heterogeneous and depends on the age of onset and pathogenesis but includes bowing deformities of the legs, short stature and widening of joints. The disorder can be caused by nutritional deficiencies or genetic defects. Mutations in genes encoding proteins involved in vitamin D metabolism or action, fibroblast growth factor 23 (FGF23) production or degradation, renal phosphate handling or bone mineralization have been identified. The prevalence of nutritional rickets has substantially declined compared with the prevalence 200 years ago, but the condition has been re-emerging even in some well-resourced countries; prematurely born infants or breastfed infants who have dark skin types are particularly at risk. Diagnosis is usually established by medical history, physical examination, biochemical tests and radiography. Prevention is possible only for nutritional rickets and includes supplementation or food fortification with calcium and vitamin D either alone or in combination with sunlight exposure. Treatment of typical nutritional rickets includes calcium and/or vitamin D supplementation, although instances infrequently occur in which phosphate repletion may be necessary. Management of heritable types of rickets associated with defects in vitamin D metabolism or activation involves the administration of vitamin D metabolites. Oral phosphate supplementation is usually indicated for FGF23-independent phosphopenic rickets, whereas the conventional treatment of FGF23-dependent types of rickets includes a combination of phosphate and activated vitamin D; an anti-FGF23 antibody has shown promising results and is under further study.

Non-invasive high-intensity focused ultrasound for UV-induced hyperpigmentation in Fitzpatrick skin types III and IV: a prospective, randomized, controlled, evaluator-blinded trial.

Skin hyperpigmentation is a frequently encountered problem, particularly in darker skin types. Unfortunately, standard treatments for this condition have shown disappointing results. High-intensity focused ultrasound (HIFU) is commonly indicated for skin laxity, but recently was used to treat UV-induced hyperpigmentation in animal models. This study is aimed to evaluate the efficacy and safety of high-intensity focused ultrasound for UVB-induced hyperpigmentation in human subjects. A randomized, evaluator-blinded pilot study was conducted on 20 subjects. Each subject was induced three hyperpigmentary spots by local broadband UVB. After 2weeks, each spot was randomly allocated to control, low-energy, and high-energy HIFU. Subjects were instructed to follow up weekly for a duration of 1month. Lightness index measurements, mean improvement scores, subjects' satisfaction, pain scores, and side effects were evaluated. All 20 subjects completed the study. Fourteen subjects had Fitzpatrick (FPT) skin type III and six subjects had FPT skin type IV. Twelve subjects showed greater improvement at control sites while eight subjects showed greater improvement at HIFU-treated sites. In FPT skin type III, HIFU appeared to be inferior to control in both lightness index and mean improvement scores, but in FPT skin type IV, HIFU had greater lightness index improvement and higher improvement scores than control. Side effects were more frequent in high-energy-treated areas. Focused ultrasound may be offered in some patients with hyperpigmentary conditions. More research is needed to determine proper energy settings for optimal outcome.

Not Just Skin Deep: Systemic Disease Involvement in Patients With CutaneousLupus.

Cutaneous lupus erythematosus, specifically discoid lupus erythematosus, disproportionately affects those with skin of color and may result in greater dyspigmentation and scarring in darker skin types. In this article, we review investigations relevant to cutaneous lupus patients with skin of color at University of Texas Southwestern Medical Center, associations and risk of progression to systemic lupus, and recommendations for monitoring for systemic disease spread. Between 5% and 25% of patients with cutaneous lupus can develop systemic lupus. If they progress to systemic disease, patients often develop mild systemic disease with primarily mucocutaneous and musculoskeletal manifestations. Patients with cutaneous lupus should be followed up closely to monitor for systemic disease involvement. The University of Texas Southwestern Cutaneous Lupus Erythematosus Registry, of which almost two thirds of participants are those with skin of color, is a part of an ongoing effort to better understand the pathophysiologic mechanisms of CLE and to identify prognostic indicators of risk of progression to systemic lupus.

The State of Ethnic Dermatology in Canada.

Approximately 30% of Canadians will be members of a visible minority by 2031. When dermatology became an independent medical discipline in the late 18th and early 19th centuries, most residents of Canada and the United States were of Northern European descent. Morphology and descriptions of dermatoses are based on patients with light skin. Skin of colour dermatology refers to a unique field in dermatology dedicated to the diagnosis and management of disorders that are more prevalent in patients with moderately to richly pigmented skin. Important differences in the presentation of common dermatoses such as seborrheic dermatitis and acne exist in patients with darker skin types. The effect of traditional treatments for common and uncommon dermatoses is also an important consideration in managing patients with skin of colour. Such treatments may result in adverse effects such as postinflammatory hyperpigmentation or keloid scarring at a higher rate. Most respondents from a 2013 UK study of dermatology residents and consultants agreed that individuals with 'ethnic skin' had specific and unique dermatological problems. The Royal College of Physician and Surgeons of Canada's Objectives of Training in Dermatology states that residents must demonstrate the requisite knowledge, skills, and attitudes for effective patient-centred care and service to a diverse population. Future steps include creating a national society of dermatologists interested in clinical and academic aspects of ethnic dermatology. As well, presentations on skin of colour dermatology could be encouraged at major Canadian dermatology meetings.

Melasma: an Up-to-Date Comprehensive Review.

Melasma is a common acquired condition of symmetric hyperpigmentation, typically occurring on the face, with higher prevalence in females and darker skin types. Multiple etiologies, including light exposure, hormonal influences, and family history, have been implicated in the pathogenesis of this disorder. Overall prevalence ranges widely at 1–50%, since values are typically calculated within a specific ethnic population within a geographic region. Histologically, melasma can display increased epidermal and/or dermal pigmentation, enlarged melanocytes, increased melanosomes, solar elastosis, dermal blood vessels, and, occasionally, perivascular lymphohistiocytic infiltrates. Various topical, oral, and procedural therapies have been successfully used to treat melasma. Traditional topical therapies including hydroquinone, tretinoin, corticosteroids, and triple combination creams; however, other synthetic and natural topical compounds have also shown varying efficacies. Promising oral therapies for melasma include tranexamic acid, Polypodium leucotomos, and glutathione. Procedures, including chemical peels, microneedling, radiofrequency, and lasers, are also often used as primary or adjunctive treatments for melasma. Notably, combination therapies within or across treatment modalities generally result in better efficacies than monotherapies. This review serves as a comprehensive update on the current understanding of the epidemiology, pathogenesis, clinical and histologic features of melasma, as well as treatments for this common, yet therapeutically challenging, condition.

Recognizing Latinos' range of skin pigment and phototypes to enhance skin cancer prevention.

Latinos in the United States may have the mistaken assumption that their natural pigmentation protects them from developing skin cancer that, effectively, serves as a barrier to Latinos receiving education in primary and secondary prevention of skin cancer. Latino adults of Mexican or Puerto Rican heritage attending community health fairs in the greater Chicago area responded to a culturally informed and sensitive measure for sunburn and tan, which was previously adapted to capture skin irritation with tenderness from the sun occurring in darker skin types (n=350). By self-reported responses and spectrophotometry assessment of constitutive pigmentation, adapted Fitzpatrick skin types (FST) ranged from skin type I-IV in the Mexican American participants and from II to V in the Puerto Rican participants. The objectively measured proportion of adapted FST II skin type was greater than commonly perceived and demonstrated that many Latinos do indeed have sun-sensitive skin.

Histologic changes associated with talaporfin sodium-mediated photodynamic therapy in rat skin.

Alternative treatments are needed to achieve consistent and more complete port wine stain (PWS) removal, especially in darker skin types; photodynamic therapy (PDT) is a promising alternative treatment. To this end, we previously reported on Talaporfin Sodium (TS)-mediated PDT. It is essential to understand treatment tissue effects to design a protocol that will achieve selective vascular injury without ulceration and scarring. The objective of this work is to assess skin changes associated with TS-mediated PDT with clinically relevant treatment parameters. We performed TS (0.75 mg/kg)-mediated PDT (664 nm) on Sprague Dawley rats. Radiant exposures were varied between 15 and 100 J/cm2 . We took skin biopsies from subjects at 9 hours following PDT. We assessed the degree and depth of vascular and surrounding tissue injury using histology and immunohistochemical staining. TS-mediated PDT at 0.75 mg/kg combined with 15 and 25 J/cm2 light doses resulted in vascular injury with minimal epidermal damage. At light dose of 50 J/cm2 , epidermal damage was noted with vascular injury. At light doses >50 J/cm2 , both vascular and surrounding tissue injury were observed in the forms of vasculitis, extravasated red blood cells, and coagulative necrosis. Extensive coagulative necrosis involving deeper adnexal structures was observed for 75 and 100 J/cm2 light doses. Observed depth of injury increased with increasing radiant exposure, although this relationship was not linear. TS-mediated PDT can cause selective vascular injury; however, at higher light doses, significant extra-vascular injury was observed. This information can be used to contribute to design of safe protocols to be used for treatment of cutaneous vascular lesions. Lasers Surg. Med. 49:767-772, 2017. © 2017 Wiley Periodicals, Inc.

Efficacy of Nd:YAG laser therapy for the treatment of verrucae: a literature review.

Verrucae are benign epithelial proliferations, characteristically 1-20mm in diameter, caused by human papilloma virus (HPV) infection occurring on the skin and mucosa (Photomed Laser Surg 33(6):338-42, 2015; Lasers Med Sci 29(3):1111-6, 2014). Prevalence of verrucae is 5-20% in children and young adults with peak incidence reported during teenage years (Lasers Med Sci 29(3):1111-6, 2014; J Am Acad Dermatol 22(4):547-66, 1990; J Korean Med Sci 24(5):889-93, 2009). Patients often express significant displeasure with quality of life due to this cosmetic insecurity, as well as functional problems and physical discomfort when they occur on palms of hands and soles of feet. Traditional therapeutic options for warts, such as topical salicyclic acid, topical imiquimod, bleomycin injections, cryotherapy, surgical excision, and electrocautery, have proven somewhat effective but often lead to high recurrence rates or scarring (Photomed Laser Surg 33(6):338-42, 2015). Laser therapy offers an alternative solution by employing selective tissue destruction with minimal risks. We performed a broad literature search in PubMed to obtain all available published articles that studied the treatment of verrucae on the skin with 1064-nm neodymium-doped yttrium aluminum garnet laser. This laser is specifically suited for verruca treatment due to its deeply penetrating 1064-nm wavelength and relatively low risk of pigmentation changes in dark skin types (Photomed Laser Surg 33(6):338-42, 2015). Laser therapy is effective in the treatment of verrucae and has enabled clinicians to provide direct, targeted treatment of warts.

Prevention of postoperative scars in dark skin types using a fractional carbon dioxide laser

Prevention of postoperative scars in dark skin types using a fractional carbon dioxide laser

Chemical Peels: A Must Have Armamentarium

Chemical peeling is one of the most commonly performed cosmetic procedures in any aesthetic practice, for the controlled breakdown of a part or the entire epidermis (with or without the dermis), leading to exfoliation and removal of the superficial layer of the skin. This leads to regeneration of new epidermal and dermal tissues. A chemical peel is a versatile tool in a cosmetologist’s armamentarium which is simple to use and is result oriented. It is also perhaps the most lucrative procedure for any physician; hence, becoming one of the most commonly practiced cosmetic procedures by any new practitioner. Treating various skin types can however be challenging due to the unpredictability of peels, especially when using deep chemical peels or higher concentration peels on darker skin types. Although, various parameters such as time, concentration and erythema are taken into consideration for safety purposes, the methods and procedures vary slightly depending upon the physician’s expertise in the procedure. Having performed more than 6000 chemical peels, this article is based on my practical experience and knowledge about chemical peeling, especially on darker skin types.

Review in peeling complications.

Chemical peeling, a procedure wherein a chemical agent is applied to the skin to cause controlled destruction followed by regeneration and remodeling, is a dynamic tool for the treatment of acne, pigmentation issues, and photoaging [Journal of cutaneous and aesthetic surgery vol. 5 (2012) 254-260]. The results and complications are related to the depth of the procedure, with deeper peels producing more marked results and higher rates of complications. Complications are more likely with darker skin types, certain peeling agents, and sun exposure after treatment [Journal of cutaneous and aesthetic surgery vol. 5 (2012) 254-260]. They can range from minor irritations and uneven pigmentation to permanent scarring. In extremely uncommon cases, the complications can be life-threatening. This knowledge is essential to prevent, reduce, and eliminate the occurrence of complications [Cirurgia dermatológica em consultório. São Paulo: Atheneu; 2009]. Swelling, pain, persistent erythema, pruritus, allergic reactions, folliculitis/acne, infection, herpes recurrence, hypopigmentation and hyperpigmentation, demarcation lines, and scarring are some of the complications that will be discussed in this article. The first step in preventing complications is to identify the patients at risk. By doing so, complications can be anticipated, prevented, and, if they still occur, treated as early as possible.

Comparison of Demographic and Photobiological Features of Chronic Actinic Dermatitis in Patients With Lighter vs Darker Skin Types

Chronic actinic dermatitis (CAD) is classically described in older, white men, although increasing reports describe younger patients with darker skin types, particularly South Asians. Photocontact allergy occurs in CAD but is less studied than contact allergy in this exquisitely photosensitive condition. To evaluate for differences in demographic and photobiological features between persons with darker and lighter skin types who have CAD. This retrospective review included 70 consecutive adult patients (≥18 years) undergoing investigation for photosensitivity who were diagnosed with CAD from November 1, 2000, through August 31, 2015, at the specialist Photobiology Unit of a tertiary academic referral center. Patient age, sex, ethnicity, clinical features, and phototesting outcomes. A total of 70 patients (37 men [53%] and 33 women [47%]; mean [SD] age, 50.9 [2.3] years) were diagnosed with CAD. Of these, 36 were non-Hispanic and non-Latino white, 31 were Asian (including 24 South Asian, 4 East Asian, and 3 Middle Eastern), and 3 were black. Patients were aged 9 to 83 years at diagnosis, with a mean (SD) age at onset of 42.6 (2.4) years and duration of disease of 8.8 (1.3) years. Forty-one had lighter skin types (Fitzpatrick skin types I-IV), and 29 had darker skin types (Fitzpatrick skin types V and VI). Patients with darker skin types and CAD were younger at diagnosis (mean [SD] age, 40.7 [3.5] vs 58.1 [2.5] years; P < . 001) and had earlier onset of photosensitivity (mean [SD] age, 35.5 [3.9] vs 47.5 [2.9] years; P = .01) compared with patients with lighter skin types. Of note, the male to female ratio in the lighter skin group was 2:1 compared with 1:2 in the darker skin group. Phototest reactions were equally severe in Fitzpatrick skin types V to VI and I to IV, with minimal erythemal doses to monochromatic UV-B, UV-A, and visible radiation and broadband provocation testing showing similar results. Photoallergic contact reactions to UV filters, personal sunscreen products, and nonsteroidal anti-inflammatory drugs were seen in both groups; 14 of 61 patients (23%) undergoing photopatch testing showed positive photopatch reactions. Chronic actinic dermatitis presents with an earlier age at onset and an inverted male to female ratio in patients with darker compared with lighter skin types. Clinicians should thus be cognizant of CAD in younger women with darker skin types. Photopatch testing should be considered in patients with CAD, with coexistent photocontact allergy occurring in a substantial proportion.

Picosecond 532 nm Neodymium-Doped Yttrium Aluminium Garnet Laser for the Treatment of Solar Lentigines in Darker Skin Types: Safety and Efficacy.

Given the more focused thermal activity of picosecond lasers, we hypothesized that treatment of lentigos with a picosecond 532-nm neodymium-doped yttrium aluminium garnet (Nd:YAG) laser would be both efficacious and well tolerated in skin Type IV patients.Dyspigmentation of the face including solar

Efficacy and safety of 70% glycolic acid versus Q Switched Nd:YAG laser in the treatment of melasma: acomparative study

&lt;p&gt;&lt;strong&gt;Background: &lt;/strong&gt;Melasma is an acquired hypermelanosis characterized by light-to-deep brown pigmentation over cheeks, forehead, upper lip, and nose. Treatment of this condition is difficult and associated with high recurrence rates. Among newer therapies, there is interest in the use of glycolic acid peels and Q-switched Nd:YAG laser (QSNYL). The aim of the present study was to compare the therapeutic efficacy and in melasma. &lt;/p&gt;&lt;p&gt;&lt;strong&gt;Methods:&lt;/strong&gt; 60 patients of melasma were included. They were randomly divided in two groups (Group A = 30 patients treated with glycolic acid and Group B = 30 patients treated with QSNYL). Out of the 60 patients included, 26 patients in Group A, 24 patients in Group B completed the study. Response to treatment was assessed using MASI scores. &lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;The peak incidence of melasma was seen in the age group 31-40 years. Female preponderance was seen in the study (F: M-6.6:1). Sunlight was the common aggravating factor in both the groups (30%). Malar type was the most common (51.7%) observed in both the groups. MASI scores improved from 7.14 to 4.99 with glycolic acid peel and from 6.17 to 4.67 in the laser group at the end of the study. The common adverse effect observed in the study was erythema in both the groups. Postinflammatory hyperpigmentation was frequent in laser treated patients.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Conclusion:&lt;/strong&gt; 70% Glycolic peels were better than Q switched Nd:YAG laser for the treatment of melasma. Among patients treated with laser postinflammatory hyperpigmentation was a significant side effect especially in darker skin types.&lt;/p&gt;

Treatment of Acne Scars on Darker Skin Types Using a Noninsulated Smooth Motion, Electronically Controlled Radiofrequency Microneedles Treatment System.

Noninvasive technologies for treating acne scars use radiofrequency (RF)-emitting microneedles for both mechanical disruption of fibrotic strands and heat-mediated collagen remodeling. Efficacy and safety evaluation of electronically controlled noninsulated RF microneedling system on acne scars in patients with dark skin. Nineteen patients, 24 to 51 years old, skin types III to V, with acne scars were enrolled in the study. Each patient had 3 treatment sessions at monthly intervals using a multisource RF treatment platform with a microneedle RF applicator. Efficacy was evaluated by the Goodman and Barron's Global Qualitative Acne Scarring System. No bleeding points occurred during treatments. Post-treatment erythema was observed immediately after the treatment and lasted up to 10 hours after the treatment. Improvement of at least 1 acne scar grade was noted in 11 of 19 patients (57.9%) after 1 month and in 9 of 9 patients (100%) after 3 months. The tested noninsulated electronically controlled RF microneedles were found to be safe and efficient in the treatment of atrophic acne scars in skin types III to V with minimal pain or downtime.

Laser treatment of infantile hemangiomas

Infantile hemangiomas (IHs) are the most common benign soft tissue tumor of infancy and childhood. Many patients seek early treatment to halt progression of tumor growth and accelerate regression to achieve quick resolution with good cosmetic outcomes. We reviewed literature through PubMed search on the treatment strategies for IH and share our experience in the field of laser treatment of IH. Treatment strategies for IH include both pharmacological, laser, and surgical interventions depending on the stage and severity of the lesion. Various laser beams have been attempted with varying effects and effectiveness. The 595-nm pulsed dye laser therapy has been most widely utilized owing to its great efficacy but minimal adverse effects. It works by targeting oxyhemoglobin chromophore in blood vessels located within the dermis, causing photothermal damage of these target vessels stimulating quick involution without damaging surrounding healthy skin. It is especially useful in treating ulcerated superficial facial hemangiomas that necessitate rapid healing to avoid unsightly scarring. It has a good safety profile but small risk of epidermal burn, blistering, postinflammatory pigment changes, and scarring remains in those with darker skin types treated with higher fluences and short-pulsed duration. Combination treatment with 1064 nm neodymium-doped yttrium aluminum garnet laser, oral propranolol, and even corticosteroids remains an option, especially in treatment of deep, large, and functionally threatening IH. Careful consideration in consultation with the child's parents given the complexities and potential complications surrounding treatment should always be considered. Laser treatment remains an appropriate treatment for rapidly growing IH in exposed locations at early presentation.

Lazer Epilasyona Bağlı Cilt Lezyonlarının Malpraktis Açısından Değerlendirilmesi

Amaç: Günümüzde tüm dünyada epilasyon amacıyla Ruby, Alexandrite, Diode ve Neodymium: yttrium-aluminum-garnet (Nd:YAG) laser ci- hazları sıklıkla kullanılmaktadır. Laser epilasyon işleminin mekanizması; milisaniyelik atım süreleri ile kıl folikülündeki melanini hedefleyerek kıl köklerinde selektif fototermoliz meydana getirmektir. Yan etki olarak özellikle koyu renkte ciltlerde; ciltte yanık, ince epidermal kurutlanma, hiperpigmentasyon, hipopigmentasyon ve hatta skarlaşmaya neden olabilmektedir. Bu nedenle cilt türüne göre uygun dalga boyunda lazer kaynağı seçilmesi, istenmeyen cilt lezyonlarının önüne geçilmesi açısından ön koşul olarak kabul edilmektedir. Lazer epilasyon işleminin yasal çerçevesi tüm dünyada olduğu gibi ülkemizde de hayli tartışmalı durumdadır. Bu çalışmada lazer epilasyona bağlı gelişen cilt lezyonu olgularının malpraktis açısından değerlendirilmesinde ve raporlama süreçlerinde karşılaşılabilecek problemleri ortaya koymak ve çözüm önerileri sunmak amaçlanmıştır.Gereç ve Yöntem: 2006-2016 yılların arasında adli rapor düzenlenmek üzere Mersin Üniversitesi Tıp Fakültesi Adli Tıp Anabilim Dalına gönderilen 14 lazer epilasyona bağlı gelişen cilt lezyonu olgusu, retrospektif olarak, sosyodemografik özellikleri, muayene ve konsültasyon bulguları, adli rapor sonuçları, uygulamanın yapıldığı yer, uygulayıcı kişi ve hukuki özellikleri dikkate alınarak malpraktis açısından değerlendirilmiştir.Bulgular: Olguların 12’si kadın olup yaş ortalaması 31,21 ± 8,52 bulundu. En sık 25-29 yaş ve 40-44 yaş grubunda oldukları tespit edildi. Olguların sıklıkla olaydan hemen sonraki ilk birkaç gün içerisinde ya da olay üzerinden 1-2 yıl geçtikten sonra şikayetçi oldukları gözlemlendi. En sık görülen lezyonların sırasıyla hiperpigmentasyon (n:7), hipopigmentasyon (n:5), skar (n:3) olduğu, lokalizasyon olarak yüz bölgesi 8 olgu ile en sık, alt ekstremite 5 ile ikinci sıklıkta olduğu görüldü. 9 olgu için Dermatoloji konsültasyonu istenilmiş olup, bunlardan 8 olguya “tespit edilen lezyonların lazer uygulamasına bağlı gelişen komplikasyon olduğu” şeklinde yanıt verilmiştir. 12 olguda uygulama “Güzellik ve Estetik Merkezlerinde” “Güzellik Uzmanlarınca” yapılmış olup, diğer iki olguda “Özel Tıp Merkezlerinde” doktor gözetiminde yine “Güzellik Uzmanlarınca” yapılmış olduğu tespit edildi.Sonuç: Yazarlar olarak lazer epilasyonun işleminin tıbbi bir uygulama olduğunu, mutlaka standart eğitimden geçmiş bir tabip ya da uzman tabip tarafından ya da tabip gözetiminde aynı eğitimi almış ve sertifiye sağlık mesleği mensubu tarafından ve sağlık kuruluşlarında uygulanması gerektiğini düşünüyoruz.

Combination therapy in skin of color including injectables, laser, and light devices.

With the rapid increase in patients seeking cosmetic treatments, the variation in responses of lightly pigmented skin versus darkly pigmented skin has become increasingly apparent. Despite extensive treatment options in patients with skin of color, there is a paucity of well-designed studies performed on this patient population. The lack of research is concerning, as it is well documented that patients with darker skin types are at an increased risk of adverse events when treated with many of the available modalities used in cosmetic procedures. Fortunately, by combining a variety of treatments, these risks may be abrogated, and combination treatments may be a promising regimen for a wide variety of cosmetic complaints. An overview and evaluation of the research of combination therapy in skin of color is presented.

Cosmeceuticals in skin of color.

Patients with skin of color have similar skin care needs as lighter-skin patients. However, they are less likely to use sun protection on a daily basis, which leads to an increased risk of dyschromia, skin cancer, and other disorders. This article discusses the importance of a correct and consistent skin care regimen and the various cutaneous issues that should be considered when prescribing a skin care regimen for patients with darker skin types. Adopting a standardized methodology to identify affordable, efficacious products and to streamline the process of skin-type diagnosis, skin care regimen prescribing, patient communication, and staff education will result in improved patient outcomes and increased patient satisfaction.

Evidence-based management of melasma: contributing factors and treatment options

Melasma, a skin condition of adults in which light to dark brown or greyish patches of pigmentation develop mainly on facial skin, is one of the most common pigmentary disorders seen by health professionals. The condition is more common in women, especially those with darker skin types, than in men; however, one in four men with darker skin types can be affected. Treating melasma poses challenges for health professionals due to its multifactorial pathology. Even though melasma is a widely recognised cause of significant psychological distress, there is a lack of systematic and clinically usable treatment algorithms and guidelines for melasma management. This article explores the causes of epidemiology of melasma and explains recommended treatments. Aesthetic practitioners are well placed to offer patient education and provide corrective treatments, including topical solutions, sun protection, chemical peels and laser procedures.