The modified Fitzpatrick skin type classification system contains six categories with types I–IV describing different types of white skin and type V “brown” and type VI “black” skin. Postinflammatory hyperpigmentation may also occur as a complication of a chemical peeling.Īlthough this pigmentary change can be observed in all skin types, it more frequently affects individuals with higher degrees of skin pigmentation (meaning Fitzpatrick skin types IV–VI) due to increased reactivity of melanocytes within the skin. Common causes of include acne vulgaris, eczematous dermatoses, and burn injury. Postinflammatory hyperpigmentation is a reactive hypermelanosis of the skin that occurs as a sequela of cutaneous inflammation. Like hypopigmentation, hyperpigmentation disorders may be congenital or acquired. As soon as the pigment lies deeper in the skin (dermal pigmentation), the hyperpigmentation acquires a gray-brown to gray-blue glow. ![]() ![]() Superficial hyperpigmentation is located in the epidermis and causes a light- to dark-brown discoloration. Hyperpigmentation is the darkening or increase in the natural color of the skin and results from overproduction or abnormal release of melanin in the epidermis and/or dermis in response to either endogenous or exogenous inflammatory conditions. It is advised to first try the conservative options and to dose and monitor the treatment to prevent overshoot and complications. Treatment options are discussed and include camouflage therapy, topical treatments, chemical peels, laser therapy, dermatography, dermabrasion, microneedling, skin grafting, cell therapy, and excision. Also scar assessment scales with subscales for color and pigmentation are convenient and validated methods for quantitative evaluation of skin pigment disorders. Simple and easy-to-use measurement instruments are available based on spectrophotometric techniques. To determine the severity of pigmentation problems and for therapeutic evaluation, different subjective and objective methods have been validated. The role of melanocytes and the maturation of pigmentation problems are discussed. Both hypopigmentation and hyperpigmentation can cause esthetic and psychological issues, which may influence quality of life. Pigmentation problems are a common consequence of deep partial- and full-thickness burns, other skin trauma or disease, and surgical procedures. ![]() This chapter provides an overview of the epidemiology, pathophysiology, course, measurement, and potential therapies for pigmentation disorders in scars.
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