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Prevention and Treatment of Skin Pigmentation Disorders

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A special issue of Journal of Clinical Medicine (ISSN 2077-0383). This special issue belongs to the section "Dermatology".

Deadline for manuscript submissions: closed (30 April 2024) | Viewed by 25873

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Dr. Ziad Khamaysi

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Dermatology Department of Rambam Health Care Campus (Haifa) and the Technion, Haifa 3109601, Isreal
Interests: laser in dermatology; aesthetic treatment; hidradinitis supporativa; cutaneous vascular lesions and infantile hemangioma; genodermatosis

Special Issue Information

Dear Colleagues,

Pigmentation disorders are commonly encountered in dermatology practice. They are classified in hypo- or hyperpigmentation, which can occur as a genetic or acquired disease. Hyperpigmentation could be a result of excess melanin production, distribution, or transport. Common etiologies include postinflammatory hyperpigmentation, melasma, solar lentigines, ephelides, and café au lait macules. Generalized hyperpigmentation rarely reflects a primary genetic disorder but is most often from acquired diseases such as Addison disease, secondary hemochromatosis, or primary biliary cirrhosis. Although they are often benign and clinically diagnosed based on appearance and location, it may be necessary to perform a skin biopsy to determine a definite diagnosis or to exclude melanoma. Usually, these disorders have cosmetic or psychological concerns to the patient, necessitating further evaluation and treatment. Depending on their severity and underlying condition, hyperpigmentation could be treated with topical or oral agents, chemical peels, cryotherapy, light, or laser therapy.

Hypopigmentation disorders can result from abnormalities in the migration of melanocytes during embryogenesis. In addition, the impairment of melanosome transfer to the surrounding keratinocytes, an alteration in melanin synthesis and defective degradation or removal of melanin may lead to abnormal skin pigmentation. The destructions of melanocytes mediated by immunologic or toxic factors can end in pigmentation disorders. These disorders include congenital hypopigmentation, which can be restricted to the skin as in piebaldism, or they represent a systemic disease, such as Menkes disease or phenylketonuria. In addition to common hyperpigmentation disorders, other disorders include post-inflammatory hypopigmentation, vitiligo, pityriasis alba, and tinea versicolor. Part of the hypopigmentation disorders may improve or resolve with treatment of the underlying condition. The treatment of pigmentation disorders are based on a diagnosis that sometimes allow for a specific intervention. Cosmetically acceptable results are difficult to obtain.

Dr. Ziad Khamaysi
Guest Editor

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Keywords

hyperpigmentation
hypopigmentation
melasma
vitiligo
albinism
post-inflammatory hyperpigmentation
post-inflammatory hypopigmentation
café-au-lait spots
lentigines
laser and light-based devices

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Published Papers (9 papers)

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Editorial

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3 pages, 141 KiB

Open AccessEditorial

Prevention and Treatment of Skin Pigmentation Disorders

by Ziad Khamaysi and Badea Jiryis

J. Clin. Med. 2024, 13(15), 4312; https://doi.org/10.3390/jcm13154312 - 24 Jul 2024

Viewed by 1265

Abstract

Pigmentation disorders are conditions that affect the color of a person’s skin [...] Full article

(This article belongs to the Special Issue Prevention and Treatment of Skin Pigmentation Disorders)

Research

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9 pages, 1992 KiB

Open AccessArticle

Exploring the Severity Strata of Disease Activity and Repigmentation in Vitiligo Based on Validated Physician Global Assessment (PGA) Scores

by Nanja van Geel, Liesbeth Delbaere, Laura Mertens, Virginie Vandaele, Lien Depaepe, Jérôme Van Causenbroeck, Sofie De Schepper, Laura Van Coile, Astrid Van Reempts, Ann-Sophie De Vos, Jorien Papeleu, Isabelle Hoorens, Albert Wolkerstorfer and Reinhart Speeckaert

J. Clin. Med. 2024, 13(9), 2680; https://doi.org/10.3390/jcm13092680 - 2 May 2024

Viewed by 1017

Abstract

Background/Objectives: There is currently no guidance on how to interpret the global degrees of activity (worsening) and repigmentation (improvement) in vitiligo. Stratification into global degrees can be completed for static evaluations (e.g., visible disease activity signs) and dynamic assessments (e.g., evolution over time). For the latter, the Vitiligo Disease Activity Score (VDAS_15&60) and Vitiligo Disease Improvement Score (VDIS_15&60) were recently validated. Methods: In the current study, a Physician Global Assessment (PGA) for disease activity (worsening) and repigmentation (improvement) was evaluated for validity (construct) and reliability (inter- and intrarater) based on a photo set of 66 patients. Subsequently, the PGA activity (worsening) and repigmentation (improvement) were used to stratify the Vitiligo Extent Score plus (VESplus), VDAS_15&60 or VDIS_15&60 into three global categories (slightly, moderately and much worse/improved), based on ROC analysis. Results: For the VESplus, cut-off values for the categories ‘slightly, moderately and much worse’ were >0.3%, >27.71% and >128.75% BSA (relative changes in the affected total BSA), respectively. For the categories ‘slightly, moderately and much improved’, they were >0%, >4.87% and >36.88% BSA (relative changes in the affected total BSA), respectively. The optimal cut-off values of the number of active (VDAS₁₅) body areas were >0 areas for slightly worse, >2 areas for moderately worse and >7 for much worse. For VDIS₁₅, the cut-off values for slightly improved and moderately improved were >0 and >1. For VDAS₆₀ and VDIS₆₀, the cut-off points were >0.5, >3, >9.5 and >0.5 and >1.5, respectively. The results should be interpreted with caution in patients with extensive vitiligo due to the rather limited disease extent of the included patient population (VESplus (median: 3.2%)). Conclusions: This research will aid in the development of more detailed international definitions. Full article

(This article belongs to the Special Issue Prevention and Treatment of Skin Pigmentation Disorders)

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12 pages, 1738 KiB

Open AccessArticle

Skin Color Analysis of Various Body Parts (Forearm, Upper Arm, Elbow, Knee, and Shin) and Changes with Age in 53 Korean Women, Considering Intrinsic and Extrinsic Factors

by Eun Ju Lee, Ja Hyun Ryu, Ji Hwoon Baek and Yong Chool Boo

J. Clin. Med. 2024, 13(9), 2500; https://doi.org/10.3390/jcm13092500 - 24 Apr 2024

Cited by 3 | Viewed by 1710

Abstract

Background/Objectives: Skin color is innately determined by race and other genetic factors, and it also undergoes acquired changes due to various intrinsic and extrinsic factors. Previous studies on skin color have mainly focused on the face, and research has recently expanded to other body parts. However, there is limited information about the age-dependent changes in the skin color of these body parts. The purpose of this study is to analyze the differences in skin color between various body parts and the changes in skin color of each body part with age. Methods: This study examined the skin color of 53 Korean women subjects evenly distributed in age from the 20s to 60s on several body parts: forearm, upper arm, elbow (extended or folded), knee (extended or folded), thigh, and shin. The lightness (L*), redness (a*), and yellowness (b*) were measured using a spectrophotometer, and the individual typology angle (ITA°) was calculated from the L* and b* values. The melanin index and erythema index were measured using the mexameter. Results: The results showed that the elbow skin had the lowest L* and ITA° values and the highest a* and b* values among the examined body parts, followed by the knee. The melanin index and erythema index were also high in the skin of these body parts. In the analysis of age-dependent changes in the skin color of various body parts, the forearm skin exhibited the most notable decrease in the L* and ITA° values and increases in the a* and b* values, followed by upper-arm skin. The melanin and erythema indices in the forearm also increased as the subjects aged, whereas those in the elbow and knee rather decreased with age. Conclusions: This study suggests that differences in intrinsic and extrinsic skin aging in various body parts may be expressed as different changes in skin color and raises the need for cosmetic and dermatological research to identify the physiological significance of these changes. Full article

(This article belongs to the Special Issue Prevention and Treatment of Skin Pigmentation Disorders)

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12 pages, 5078 KiB

Open AccessArticle

Pilot Study to Demonstrate Improvement in Skin Tone and Texture by Treatment with a 1064 nm Q-Switched Neodymium-Doped Yttrium Aluminum Garnet Laser

by Girish S. Munavalli and Hayley M. Leight-Dunn

J. Clin. Med. 2024, 13(5), 1380; https://doi.org/10.3390/jcm13051380 - 28 Feb 2024

Viewed by 1475

Abstract

Background: The 1064 nm Q-switched neodymium-doped yttrium aluminum garnet (QS Nd:YAG) laser was developed to treat unwanted pigmentation in the skin such as lentigines caused by photoaging, and tattoos from dye/ink insertion. This laser has also been used for non-ablative epidermal rejuvenation (skin toning). Objective: To evaluate changes in skin tone, skin texture and overall improvement after a series of treatments with the QS Nd:YAG laser. Methods: Participants received seven full-face treatments with M22 or Stellar M22, a 1064 nm QS Nd:YAG laser, at 2-week intervals. The investigators and participants evaluated the improvement in skin tone and texture at 1, 3 and 6 months after the last treatment. Patient satisfaction, patient discomfort, downtime and adverse events were recorded. Histological changes in the treated area were also evaluated. Results: Thirteen women with a median age of 45 years (range, 34–61 years) were included in the study. The majority of the participants (53.9%) had skin type VI. One month after the last treatment session, 38% of participants reported good to very good improvement. This value increased to 100% participant improvement at both the 3-month and 6-month follow-up visits. The reduction in melanin index and the histological analysis demonstrated that the laser procedure contributed to a reduction in epidermal melanin content. Treatments were not associated with high levels of pain or discomfort. The most common immediate post-treatment response was erythema and edema. Most participants were satisfied with the resulting treatment outcome. Conclusion: Skin treatment with the 1064 nm QS Nd:YAG laser module on the M22 and Stellar M22 devices, using a large spot size, low fluence, moderately high repetition rate, improves skin tone and texture in patients with skin types II–VI. Full article

(This article belongs to the Special Issue Prevention and Treatment of Skin Pigmentation Disorders)

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11 pages, 7429 KiB

Open AccessCommunication

Hyper- and Hypopigmentation in a Subject with Fitzpatrick Skin Phototype VI: A New Treatment Option

by Sheila Veronese, Rajeev Aggarwal, Tiziana Giovanelli and Andrea Sbarbati

J. Clin. Med. 2024, 13(4), 1036; https://doi.org/10.3390/jcm13041036 - 11 Feb 2024

Viewed by 1851

Abstract

Background: Laser therapies can cause hyper- and hypopigmentation of the skin. There is little evidence in the literature of effective treatments for these types of problems in Fitzpatrick skin phototypes IV–VI. The main aim of this retrospective study is to evaluate the effects of a new therapy that combines the application of electromagnetic fields and vacuum on a subject with Fitzpatrick skin phototype VI, who presented extensive, laser-induced facial dyschromia. The secondary aim is to test the effectiveness of a free imaging software for assessing skin pigmentation. Methods: The level of improvement after therapy was evaluated, with a 5-point Likert scale, one month after the end of the treatment by the subject and by the doctor who performed the treatment, and by two blinded dermatologists. With the free software, a three-dimensional reconstruction of the treated area and the evaluation of the color distribution were performed. Results: Both the subject and the doctors involved in the study positively evaluated the effects of the treatment. The image analysis highlighted the homogenization of the skin color in the treated area. Conclusions: The combination of electromagnetic fields and vacuum for dyschromia treatments appears promising. The new method of assessing melanin levels resulted particularly efficient. Full article

(This article belongs to the Special Issue Prevention and Treatment of Skin Pigmentation Disorders)

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10 pages, 501 KiB

Open AccessArticle

Do Barrier Films Impact Long-Term Skin Toxicity following Whole-Breast Irradiation? Objective Follow-Up of Two Randomised Trials

by Cas Stefaan Dejonckheere, Kira Lindner, Anne Bachmann, Alina Abramian, Katharina Layer, Teresa Anzböck, Julian Philipp Layer, Gustavo Renato Sarria, Davide Scafa, David Koch, Christina Leitzen, Christina Kaiser, Andree Faridi and Leonard Christopher Schmeel

J. Clin. Med. 2023, 12(22), 7195; https://doi.org/10.3390/jcm12227195 - 20 Nov 2023

Cited by 1 | Viewed by 1044

Abstract

Purpose: Hydrofilm, a polyurethane-based barrier film, can be used to prevent acute radiation dermatitis (RD) in adjuvant whole-breast irradiation (WBI) for breast cancer. This cost-effective prophylactic measure is currently being recommended to a growing number of patients, yet long-term safety data and its impact on late radiation-induced skin toxicity such as pigmentation changes and fibrosis have not been investigated. Methods: We objectively evaluated patients who were previously enrolled in either of two intrapatient-randomised (lateral versus medial breast halve) controlled trials on the use of Hydrofilm for RD prevention (DRKS00029665; registered on 19 July 2022). Results: Sixty-two patients (47.7% of the initial combined sample size) provided consent for this post-hoc examination, with a median follow-up time (range) of 58 (37–73) months. Following WBI, there was a significant increase in yellow skin tones of the entire breast when compared to baseline measurements before WBI (p < 0.001) and a significant increase of cutis, subcutis, and oedema thickness (p < 0.001, p < 0.001, and p = 0.004, respectively). At follow-up, there were no significant differences in either pigmentation changes or skin fibrosis between the Hydrofilm and standard of care breast halves. Conclusion: These data suggest that Hydrofilm can be safely used in the context of acute RD prevention, without affecting late side effects, supporting its widespread use. Full article

(This article belongs to the Special Issue Prevention and Treatment of Skin Pigmentation Disorders)

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Review

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19 pages, 1993 KiB

Open AccessReview

Advancements in Laser Therapies for Dermal Hyperpigmentation in Skin of Color: A Comprehensive Literature Review and Experience of Sequential Laser Treatments in a Cohort of 122 Indian Patients

by Suruchi Garg, Kanya Rani Vashisht, Diksha Garg, Bhavni Oberoi and Geeta Sharma

J. Clin. Med. 2024, 13(7), 2116; https://doi.org/10.3390/jcm13072116 - 5 Apr 2024

Cited by 2 | Viewed by 3506

Abstract

The heightened awareness of ethnic dermatology aligns with the growing prevalence of skin of color communities globally, where hyperpigmentation disorders pose a common dermatological challenge. Effectively addressing dermal pigmentation is challenging due to its resistance to conventional therapies and its association with impaired quality of life. This underscores the need for effective treatments and a thorough grasp of laser advancements. A relevant literature search spanning the last 7 years across the PubMed database reveals core studies, challenges, and the evolution of laser technologies tailored for various forms of congenital and acquired dermal hyperpigmentation in skin of color. This comprehensive review explores the mechanisms, applications, and recommendations for pigmentary laser technologies, highlighting the key role of Q-switched lasers in their established millisecond/ nanosecond forms and emerging picosecond lasers, fractional non-ablative and ablative lasers, Intense Pulsed Light, etc. The summary of evidence includes studies on dermal melanocytosis (nevus of Ota and Hori’s nevus), tattoos, acquired dermal macular hyperpigmentation, etc., and also entities with mixed epidermal–dermal components, such as melasma and post-inflammatory hyperpigmentation. The review offers valuable insights for clinicians to make informed decisions based on diagnosis, skin type, and the latest technologies to optimize results and minimize complications, especially in darker Fitzpatrick skin types. In their five-year study with 122 Indian patients, the authors applied specific laser combinations for diverse dermal melanoses, including tattoos, dermal/mixed melasma, acquired dermal macular hyperpigmentation, and dermal nevi. Substantial pigmentation reduction, subjectively assessed by both physicians and patients, was observed across all groups. A one-way ANOVA indicated a significant difference in mean improvement scores across various pigmentary conditions (F = 3.39, p = 0.02), with melasma patients exhibiting a significantly higher improvement score than tattoos (p = 0.03). The results affirmed the safety and efficacy of sequential laser therapy for dermal pigmentation in skin of color, advocating for flexibility in approach while maintaining the rationale behind the laser sequences. Despite advancements, challenges persist, and gaps in the current literature are identified. In conclusion, this summary highlights the ongoing pursuit of optimal protocols in dermatological laser treatments for dermal melanoses, offering valuable insights for future research and clinical practice. Full article

(This article belongs to the Special Issue Prevention and Treatment of Skin Pigmentation Disorders)

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12 pages, 267 KiB

Open AccessReview

Management of Melasma: Laser and Other Therapies—Review Study

by Badea Jiryis, Ohad Toledano, Emily Avitan-Hersh and Ziad Khamaysi

J. Clin. Med. 2024, 13(5), 1468; https://doi.org/10.3390/jcm13051468 - 3 Mar 2024

Cited by 2 | Viewed by 8609

Abstract

Melasma is a commonly occurring pigmented skin condition that can significantly affect one’s appearance, described as symmetric hyperpigmentation that presents as irregular brown to gray-brown macules on various facial areas, such as the cheeks, forehead, nasal bridge, and upper lip, along with the mandible and upper arms. Due to its complex pathogenesis and recurrent nature, melasma management is challenging and the outcomes following treatment are not always deemed satisfactory. Solely treating hyperpigmentation may prove ineffective unless paired with regenerative techniques and photoprotection, since one of the main reasons for recurrence is sun exposure. Hence, the treatment protocol starts with addressing risk factors, implementing stringent UV protection, and then treatment using different strategies, like applying topical treatments, employing chemical peels, laser and light therapies, microneedling, and systemic therapy. This review aims to provide a summary of the effectiveness and safety of the frequently employed laser and light therapies for treating melasma, focusing on laser therapy as a treatment for melasma. Full article

(This article belongs to the Special Issue Prevention and Treatment of Skin Pigmentation Disorders)

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14 pages, 540 KiB

Open AccessReview

Updates on Potential Therapeutic Approaches for Vitiligo: Janus Kinase Inhibitors and Biologics

by Valentina Pala, Simone Ribero, Pietro Quaglino and Luca Mastorino

J. Clin. Med. 2023, 12(23), 7486; https://doi.org/10.3390/jcm12237486 - 4 Dec 2023

Cited by 1 | Viewed by 4235

Abstract

Vitiligo, the most prevalent skin depigmenting disease, is characterized by the selective loss of melanocytes, impacting patients’ quality of life significantly. This autoimmune disorder progresses through a complex interplay of genetic and non-genetic factors, posing challenges in comprehending its pathogenesis and devising effective treatment strategies for achieving remission. Existing conventional therapeutic approaches, such as topical and oral corticosteroids, calcineurin inhibitors, and phototherapy, lack specificity, offer modest efficacy, and may entail potential adverse effects. Consequently, there is a pressing need for a more nuanced understanding of vitiligo’s pathogenesis to pave the way for targeted therapeutic innovations. This review aims to provide a comprehensive overview of recent developments and findings concerning Januse Kinase (JAK) inhibitors and biologics tested in vitiligo patients. JAK inhibitors have exhibited promising results, showcasing both efficacy and tolerability. In contrast, the outcomes of biologics treatment have been more varied. However, to establish a clearer understanding of which specific pathways to target for a more effective approach to vitiligo, additional in vitro studies and extensive clinical research involving a larger population are imperative. Full article

(This article belongs to the Special Issue Prevention and Treatment of Skin Pigmentation Disorders)

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