Issue link: https://www.ascpskindeepdigital.com/i/1403510
54 ASCP Skin Deep September/October 2021 A protocol to treat hyperpigmentation in high-Fitzpatrick skin by Pamela Springer MANY PRACTITIONERS RELATE SKIN OF COLOR to a higher Fitzpatrick skin phototype. For individuals with phototypes III–VI, hyperpigmentation is omnipresent and manifests in different forms. The term hyperpigmentation refers to the presence of an increased amount of melanin in the skin by two main mechanisms. Melanotic hyperpigmentation is caused by increased melanin production through a normal number of melanocytes in the skin. Dermal melanosis, on the other hand, is caused by an increase of melanin production within the dermis. Usually, the basal layer (stratum basale, also called the stratum germinativum) of the epidermis contains melanocytes. An increase in activity of these cells leads to increased melanin production, which causes epidermal hyperpigmentation—the most common form of hyperpigmentation. In dermal hyperpigmentation, a transferring of epidermally produced melanin to the dermal layer can be observed. Sometimes, a combination of both these mechanisms of melanin production may take place, resulting in mixed hyperpigmentation. The visible color of hyperpigmentation depends on the location of the increased melanin production and melanin deposition. Epidermal hyperpigmentation manifests as brown lesions and is most commonly found in hyperpigmented lesions. Dermal hyperpigmentation causes blue-gray skin lesions, while mixed epidermal hyperpigmentation may result in the formation of brown-gray skin lesions. For example, melasma and post-inflammatory hyperpigmentation can be a result of epidermal, dermal, or mixed melanotic involvement. The focus in managing client hyperpigmentation should include identifying the underlying mechanism and cause. It is also essential to record the history and progress, as this information will help optimize future treatment regimens. IMPORTANT GUIDELINES Hyperpigmentation disorders can be managed by many esthetic techniques, but it is important to understand the complete background of the disorder before deciding how to manage it. Set up a few guidelines so you can accurately identify and treat hyperpigmentation while avoiding legal issues. Follow a set of regular guidelines to help increase the standard of your treatments, as well as improve the outcome of each condition. Taking an accurate medical history is crucial. Every bit of detail provided by the client will help keep you on the right track. The information clients provide is always more important than your conclusions. Hence, during history taking, make sure every question is focused on the complaints of the client. Don't forget to ask about the onset, progression, associated symptoms, and even any psychological effects experienced from the disorder. Also ask clients about any medications they take or allergic reactions they may have experienced. Family history should follow medical history. This will help reveal whether a client's hyperpigmentation is related to genetic inheritance or another kind of familial mutation. Family history will also help reveal any underlying conditions that might be the real cause of the presenting skin condition. Resources Cestari, Tania Ferreira, Lia Pinheiro Dantas, and Juliana Catucci Boza. "Acquired Hyperpigmentations." Anais Brasilerios de Dermatologia 89, no. 1 (January–February 2014): 11–25. https://doi.org/10.1590/ abd1806-4841.20142353. Davis, Erica C., and Valerie D. Callender. "Postinflammatory Hyperpigmentation: A Review of the Epidemiology, Clinical Features, and Treatment Options in Skin of Color." Journal of Clinical and Aesthetic Dermatology 3, no. 7 (July 2010): 20–31. www.ncbi.nlm.nih.gov/pmc/articles/PMC2921758. Horikoshi, Takashi, Kowichi Jimbow, and Sadao Sugiyama. "Comparison of Macromelanosomes and Autophagic Giant Melanosome Complexes in Nevocellular Nevi, Lentigo Simplex and Malignant Melanoma." Journal of Cutaneous Pathology 9, no. 5 (October 1982): 329–39. https://doi.org/10.1111/j.1600-0560.1982.tb01069.x. Volkovova, Katarina et al. "Associations Between Environmental Factors and Incidence of Cutaneous Melanoma: Review." Environmental Health 11, suppl. 1 (June 2012): S12. https://doi.org/10.1186/1476-069X-11-S1-S12. A Flawless Face