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American Journal of Clinical Dermatology

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13-02-2023 | Intense Pulsed Light | Review Article

Review of Laser Treatments for Post-Inflammatory Hyperpigmentation in Skin of Color

Authors: Madeleine Sowash, Tina Alster

Published in: American Journal of Clinical Dermatology | Issue 3/2023

Abstract

Post-inflammatory hyperpigmentation is an extremely common disorder of pigmentation in skin of color. It most frequently and severely affects phototypes that are rich in melanin and often has a chronic and unpredictable course. It presents significant treatment challenges and often requires a multi-factorial approach. We review the literature available for the optimal use of laser-based devices in the treatment of post-inflammatory hyperpigmentation, particularly for Fitzpatrick skin phototypes III–VI. For the treatment of post-inflammatory hyperpigmentation in skin of color, lasers remain second line to topical agents based on the variable response, cost, and risk of complications with laser use. For post-inflammatory hyperpigmentation resistant to topicals, laser devices, particularly neodymium:yttrium-aluminum-garnet and fractional photothermolysis systems, can provide adjunctive treatment in skin of color patients when appropriate parameters are used. Future studies would benefit from an objective and consistent assessment to assist with a systematic analysis.

Abad-Casintahan F, Chow SKW, Goh CL, et al. Frequency and characteristics of acne-related post-inflammatory hyperpigmentation. J Dermatol. 2016;43(7):826–8. https://doi.org/10.1111/1346-8138.13263.CrossRefPubMed

Raveendra L, Sidappa H, Shree S. A study of quality of life in patients with facial melanoses. Indian Dermatol Online J. 2020;11(2):154. https://doi.org/10.4103/idoj.IDOJ_209_19.CrossRefPubMedPubMedCentral

Silpa-Archa N, Kohli I, Chaowattanapanit S, Lim HW, Hamzavi I. Postinflammatory hyperpigmentation: a comprehensive overview: epidemiology, pathogenesis, clinical presentation, and noninvasive assessment technique. J Am Acad Dermatol. 2017;77(4):591–605. https://doi.org/10.1016/j.jaad.2017.01.035. (PMID: 28917451).CrossRefPubMed

Park JY, Park JH, Kim SJ, et al. Two histopathological patterns of postinflammatory hyperpigmentation: epidermal and dermal. J Cutan Pathol. 2017;44(2):118–24. https://doi.org/10.1111/cup.12849.CrossRefPubMed

Kaufman BP, Aman T, Alexis AF. Postinflammatory hyperpigmentation: epidemiology, clinical presentation, pathogenesis and treatment. Am J Clin Dermatol. 2018;19(4):489–503. https://doi.org/10.1007/s40257-017-0333-6. (PMID: 29222629).CrossRefPubMed

Agbai O, Hamzavi I, Jagdeo J. Laser treatments for postinflammatory hyperpigmentation: a systematic review. JAMA Dermatol. 2017;153(2):199–206. https://doi.org/10.1001/jamadermatol.2016.4399. (PMID: 27973642).CrossRefPubMed

Tanzi EL, Alster TS. Cutaneous laser surgery in darker skin phototypes. Cutis. 2004;73(1):21–4, 27–30 (PMID: 14964628).

Passeron T, Genedy R, Salah L, Fusade T, Kositratna G, Laubach HJ, et al. Laser treatment of hyperpigmented lesions: position statement of the European Society of Laser in Dermatology. J Eur Acad Dermatol Venereol. 2019;33(6):987–1005. https://doi.org/10.1111/jdv.15497. (Epub 2019 Mar 14, PMID: 30873649).CrossRefPubMed

Cho S, Park S, Kim J, Kim M, Bu T. Treatment of post-inflammatory hyperpigmentation using 1064-nm Q-switched Nd:YAG laser with low fluence: report of three cases. J Eur Acad Dermatol Venereol. 2009;23(10):1206–7. https://doi.org/10.1111/j.1468-3083.2009.03123.x.CrossRefPubMed

10.

Kim S, Cho K-H. Treatment of procedure-related postinflammatory hyperpigmentation using 1064-nm Q-switched Nd:YAG laser with low fluence in Asian patients: report of five cases: treatment of postinflammatory hyperpigmentation. J Cosmet Dermatol. 2010;9(4):302–6. https://doi.org/10.1111/j.1473-2165.2010.00527.x.CrossRefPubMed

11.

Zawar VP, Agarwal M, Vasudevan B. Treatment of postinflammatory pigmentation due to acne with Q-Switched neodymium-doped yttrium aluminum garnet in 78 Indian cases. J Cutan Aesthet Surg. 2015;8(4):222–6. https://doi.org/10.4103/0974-2077.172196.CrossRefPubMedPubMedCentral

12.

Kim S, Cho KH. Treatment of facial postinflammatory hyperpigmentation with facial acne in Asian patients using a Q-switched neodymium-doped yttrium aluminum garnet laser. Dermatol Surg. 2010;36(9):1374–80. https://doi.org/10.1111/j.1524-4725.2010.01643.x.CrossRefPubMed

13.

Feng J, Huang L. Treatment of permanent post-inflammatory hyperpigmentation with medium-fluence medium-spot-size setting in Q-switched Nd: YAG 1064 nm laser: a novel treatment parameters setting strategy. J Cosmet Dermatol. 2021. https://doi.org/10.1111/jocd.14176. (Epub 2021 Apr 25).CrossRefPubMed

14.

Ghannam S, Al Otabi FK, Frank K, Cotofana S. Efficacy of low-fluence Nd:YAG 1064 nm laser for the treatment of post-inflammatory hyperpigmentation in the axillary area. J Drugs Dermatol. 2017;16(11):1118–23.PubMed

15.

Robredo IGC. Q-switched 1064 nm Nd:YAG laser in treating axillary hyperpigmentation in Filipino women with skin types IV–V. J Drugs Dermatol. 2020;19(1):66–9. https://doi.org/10.36849/JDD.2020.462.3.CrossRefPubMed

16.

Amornpetkul W, Kanokrungsee S, Kamanamool N, Udompataikul M, Rojhirunsakool S. Comparison between the use of intense pulsed light and Q-switched neodymium-doped yttrium aluminum garnet laser for the treatment of axillary hyperpigmentation. J Cosmet Dermatol. 2021;20(9):2785–93. https://doi.org/10.1111/jocd.13981.CrossRefPubMed

17.

Manstein D, Herron GS, Sink RK, Tanner H, Anderson RR. Fractional photothermolysis: a new concept for cutaneous remodeling using microscopic patterns of thermal injury. Lasers Surg Med. 2004;34(5):426–38. https://doi.org/10.1002/lsm.20048. (PMID: 15216537).CrossRefPubMed

18.

Laubach HJ, Tannous Z, Anderson RR, Manstein D. Skin responses to fractional photothermolysis. Lasers Surg Med. 2006;38(2):142–9. https://doi.org/10.1002/lsm.20254. (PMID: 16392146).CrossRefPubMed

19.

Kroon MW, Wind BS, Meesters AA, et al. Non-ablative 1550 nm fractional laser therapy not effective for erythema dyschromicum perstans and postinflammatory hyperpigmentation: a pilot study. J Dermatol Treat. 2012;23(5):339–44. https://doi.org/10.3109/09546634.2011.565016.CrossRef

20.

Alharbi MA. 1927 nm thulium laser successfully treats postInflammatory hyperpigmentation in skin of color. Dermatol Res Pract. 2021;2021:5560386. https://doi.org/10.1155/2021/5560386.CrossRefPubMedPubMedCentral

21.

Bae YSC, Rettig S, Weiss E, Bernstein L, Geronemus R. Treatment of post-inflammatory hyperpigmentation in patients with darker skin types using a low energy 1,927 nm non-ablative fractional laser: a retrospective photographic review analysis. Lasers Surg Med. 2020;52(1):7–12. https://doi.org/10.1002/lsm.23173.CrossRefPubMed

22.

Katz TM, Goldberg LH, Firoz BF, Friedman PM. Fractional photothermolysis for the treatment of postinflammatory hyperpigmentation. Dermatol Surg. 2009;35(11):1844–8. https://doi.org/10.1111/j.1524-4725.2009.01303.x.CrossRefPubMed

23.

Cho SB, Lee SJ, Kang JM, Kim YK, Oh SH. Treatment of refractory arcuate hyperpigmentation using a fractional photothermolysis system. J Dermatol Treat. 2010;21(2):107–8. https://doi.org/10.3109/09546630902936794.CrossRef

24.

Lee SJ, Chung WS, Lee JD, Kim HS. A patient with cupping-related post-inflammatory hyperpigmentation successfully treated with a 1,927 nm thulium fiber fractional laser. J Cosmet Laser Ther. 2014;16(2):66–8. https://doi.org/10.3109/14764172.2013.854121.CrossRefPubMed

25.

Ren R, Zhao H. A case report on the use of 755-nm alexandrite picosecond laser in the treatment of post-inflammatory hyperpigmentation in the nose. J Cosmet Dermatol. 2021. https://doi.org/10.1111/jocd.14332. (Epub 2021 Jul 5).CrossRefPubMed

26.

Lee YJ, Shin HJ, Noh TK, Choi KH, Chang SE. Treatment of melasma and post-inflammatory hyperpigmentation by a picosecond 755-nm alexandrite laser in Asian patients. Ann Dermatol. 2017;29(6):779–81. https://doi.org/10.5021/ad.2017.29.6.779.CrossRefPubMedPubMedCentral

27.

Ren R, Bao S, Qian W, Zhao H. 755-nm Alexandrite picosecond laser with a diffractive lens array or zoom handpiece for post-inflammatory hyperpigmentation: two case reports with a three-year follow-up. Clin Cosmet Investig Dermatol. 2021;14:1459–64. https://doi.org/10.2147/CCID.S323872.CrossRefPubMedPubMedCentral

28.

Lin CH, Tsai YJ, Lin KC, et al. Laser-assisted drug delivery of tranexamic acid by picosecond laser in postinflammatory hyperpigmentation: a split-area double blind randomized prospective study. Photobiomodul Photomed Laser Surg. 2021;39(11):711–5. https://doi.org/10.1089/photob.2021.0086.CrossRefPubMed

29.

Tawfic SO, Abdel Hay R, Salim H, Elmasry MF. Tranexamic acid versus fractional carbon dioxide laser in post-acne hyperpigmentation. Dermatol Ther. 2021;34(6):e15103. https://doi.org/10.1111/dth.15103.CrossRefPubMed

30.

Oram Y, Akkaya AD. Refractory postinflammatory hyperpigmentation treated fractional CO₂ laser. J Clin Aesthet Dermatol. 2014;7(3):42–4.PubMedPubMedCentral

31.

Manuskiatti W, Triwongwaranat D, Varothai S, Eimpunth S, Wanitphakdeedecha R. Efficacy and safety of a carbon-dioxide ablative fractional resurfacing device for treatment of atrophic acne scars in Asians. J Am Acad Dermatol. 2010;63(2):274–83. https://doi.org/10.1016/j.jaad.2009.08.051.CrossRefPubMed

32.

Chan NP, Ho SG, Yeung CK, Shek SY, Chan HH. Fractional ablative carbon dioxide laser resurfacing for skin rejuvenation and acne scars in Asians. Lasers Surg Med. 2010;42(9):615–23. https://doi.org/10.1002/lsm.20974.CrossRefPubMed

33.

Taylor CR, Anderson RR. Ineffective treatment of refractory melasma and postinflammatory hyperpigmentation by Q-switched ruby laser. J Dermatol Surg Oncol. 1994;20(9):592–7. https://doi.org/10.1111/j.1524-4725.1994.tb00152.x.CrossRefPubMed

34.

Kopera D, Hohenleutner U. Ruby laser treatment of melasma and postinflammatory hyperpigmentation. Dermatol Surg. 1995;21(11):994. https://doi.org/10.1111/j.1524-4725.1995.tb00545.x.CrossRefPubMed

35.

Park KY, Choi SY, Mun SK, Kim BJ, Kim MN. Combined treatment with 578-/511-nm copper bromide laser and light-emitting diodes for post-laser pigmentation: a report of two cases: 578-/511-nm copper bromide laser with LED for PIH. Dermatol Ther. 2014;27(2):121–5. https://doi.org/10.1111/dth.12080.CrossRefPubMed

36.

Austin E, Geisler AN, Nguyen J, et al. Visible light. Part I: properties and cutaneous effects of visible light. J Am Acad Dermatol. 2021;84(5):1219–31. https://doi.org/10.1016/j.jaad.2021.02.048.CrossRefPubMedPubMedCentral

37.

Taylor SC, Alexis AF, Armstrong AW, Chiesa Fuxench ZC, Lim HW. Misconceptions of photoprotection in skin of color. J Am Acad Dermatol Epub. 2021. https://doi.org/10.1016/j.jaad.2021.12.020.CrossRef

38.

Agbai ON, Buster K, Sanchez M, et al. Skin cancer and photoprotection in people of color: a review and recommendations for physicians and the public. J Am Acad Dermatol. 2014;70(4):748–62. https://doi.org/10.1016/j.jaad.2013.11.038.CrossRefPubMed

39.

Kaye ET, Levin JA, Blank IH, Arndt KA, Anderson RR. Efficiency of opaque photoprotective agents in the visible light range. Arch Dermatol. 1991;127(3):351–5. https://doi.org/10.1001/archderm.1991.01680030071009.CrossRefPubMed

40.

Lim HW, Kohli I, Ruvolo E, Kolbe L, Hamzavi IH. Impact of visible light on skin health: the role of antioxidants and free radical quenchers in skin protection. J Am Acad Dermatol. 2022;86(3):S27-37. https://doi.org/10.1016/j.jaad.2021.12.024.CrossRefPubMed

41.

Lyons AB, Zubair R, Kohli I, et al. Mitigating visible light and long wavelength UVA1-induced effects with topical antioxidants. Photochem Photobiol. 2022;98(2):455–60. https://doi.org/10.1111/php.13525.CrossRefPubMed

42.

Segars K, McCarver V, Miller RA. Dermatologic applications of polypodium leucotomos: a literature review. J Clin Aesthet Dermatol. 2021;14(2):50–60.PubMedPubMedCentral

43.

Ishack S, Lipner SR. Exogenous ochronosis associated with hydroquinone: a systematic review. Int J Dermatol. 2021. https://doi.org/10.1111/ijd.15878. (Epub 2021 Sep 6).CrossRefPubMed

44.

Callender VD, St Surin-Lord S, Davis EC, Maclin M. Postinflammatory hyperpigmentation: etiologic and therapeutic considerations. Am J Clin Dermatol. 2011;12(2):87–99. https://doi.org/10.2165/11536930-000000000-00000.CrossRefPubMed

45.

Roggenkamp D, Dlova N, Mann T, et al. Effective reduction of post-inflammatory hyperpigmentation with the tyrosinase inhibitor isobutylamido-thiazolyl-resorcinol (thiamidol). Int J Cosmet Sci. 2021;43(3):292–301. https://doi.org/10.1111/ics.12694.CrossRefPubMedPubMedCentral

46.

Desai S, Hartman C, Grimes P, Shah S. Topical stabilized cysteamine as a new treatment for hyperpigmentation disorders: melasma, post-inflammatory hyperpigmentation, and lentigines. J Drugs Dermatol. 2021;20(12):1276–9. https://doi.org/10.36849/jdd.6367.CrossRefPubMed

47.

Mathe N, Balogun M, Yoo J. A case report on the use of topical cysteamine 5% cream in the management of refractory postinflammatory hyperpigmentation (PIH) resistant to triple combination cream (hydroquinone, topical corticosteroids, and retinoids). J Cosmet Dermatol. 2021;20(1):204–6. https://doi.org/10.1111/jocd.13755.CrossRefPubMed

48.

Chaowattanapanit S, Silpa-Archa N, Kohli I, Lim HW, Hamzavi I. Postinflammatory hyperpigmentation: a comprehensive overview: treatment options and prevention. J Am Acad Dermatol. 2017;77(4):607–21. https://doi.org/10.1016/j.jaad.2017.01.036. (PMID: 28917452).CrossRefPubMed

49.

Ho SGY, Yeung CK, Chan NPY, Shek SY, Kono T, Chan HHL. A retrospective analysis of the management of acne post-inflammatory hyperpigmentation using topical treatment, laser treatment, or combination topical and laser treatments in oriental patients. Lasers Surg Med. 2011;43(1):1–7. https://doi.org/10.1002/lsm.21010.CrossRefPubMed

50.

Kim MS, Bang SH, Kim JH, Shin HJ, Choi JH, Chang SE. Tranexamic acid diminishes laser-induced melanogenesis. Ann Dermatol. 2015;27(3):250–6. https://doi.org/10.5021/ad.2015.27.3.250. (Epub 2015 May 29. PMID: 26082580; PMCID: PMC4466276.37).CrossRefPubMedPubMedCentral

51.

Lindgren AL, Austin AH, Welsh KM. The use of tranexamic acid to prevent and treat post-inflammatory hyperpigmentation. J Drugs Dermatol. 2021;20(3):344–5. https://doi.org/10.36849/JDD.5622. (PMID: 33683077).CrossRefPubMed

52.

Lee YB, Park SM, Kim JW, Yu DS. Combination treatment of low-fluence Q-switched Nd:YAG laser and oral tranexamic acid for post-inflammatory hyperpigmentation due to allergic contact dermatitis to henna hair dye. J Cosmet Laser Ther. 2016;18(2):95–7. https://doi.org/10.3109/14764172.2015.1114634.CrossRefPubMed

53.

Kato H, Araki J, Eto H, et al. A prospective randomized controlled study of oral tranexamic acid for preventing postinflammatory hyperpigmentation after Q-Switched ruby laser. Dermatol Surg. 2011;37(5):605–10. https://doi.org/10.1111/j.1524-4725.2011.01957.x.CrossRefPubMed

54.

Rutnin S, Pruettivorawongse D, Thadanipon K, Vachiramon V. A prospective randomized controlled study of oral tranexamic acid for the prevention of postinflammatory hyperpigmentation after Q-switched 532-nm Nd:YAG laser for solar lentigines. Lasers Surg Med. 2019;51(10):850–8. https://doi.org/10.1002/lsm.23135.CrossRefPubMed

55.

Sirithanabadeekul P, Srieakpanit R. Intradermal tranexamic acid injections to prevent post-inflammatory hyperpigmentation after solar lentigo removal with a Q-switched 532-nm Nd:YAG laser. J Cosmet Laser Ther. 2018;20(7–8):398–404. https://doi.org/10.1080/14764172.2018.1444770.CrossRefPubMed

56.

Burns RL, Prevost-Blank PL, Lawry MA, Lawry TB, Faria DT, Fivenson DP. Glycolic acid peels for postinflammatory hyperpigmentation in black patients: a comparative study. Dermatol Surg. 1997;23(3):171–4. https://doi.org/10.1111/j.1524-4725.1997.tb00014.x. (discussion 175).CrossRefPubMed

57.

Joshi SS, Boone SL, Alam M, et al. Effectiveness, safety, and effect on quality of life of topical salicylic acid peels for treatment of postinflammatory hyperpigmentation in dark skin. Dermatol Surg. 2009;35(4):638–44. https://doi.org/10.1111/j.1524-4725.2009.01103.x.CrossRefPubMed

58.

Lee GY, Kim HJ, Whang KK. The effect of combination treatment of the recalcitrant pigmentary disorders with pigmented laser and chemical peeling. Dermatol Surg. 2002;28(12):1120–3. https://doi.org/10.1046/j.1524-4725.2002.02112.x. (discussion 1123).CrossRefPubMed

59.

Park JH, Kim JI, Kim WS. Treatment of persistent facial postinflammatory hyperpigmentation with novel pulse-in-pulse mode intense pulsed light. Dermatol Surg. 2016;42(2):218–24. https://doi.org/10.1097/DSS.0000000000000627.CrossRefPubMed

60.

Li N, Han J, Hu D, Cheng J, Wang H, Wang Y, Yang X, Liu J, Li T, Zhao W. Intense pulsed light is effective in treating postburn hyperpigmentation and telangiectasia in Chinese patients. J Cosmet Laser Ther. 2018;20(7–8):436–41. https://doi.org/10.1080/14764172.2017.1418517. (Epub 2018 Feb 16, PMID: 29452029).CrossRefPubMed

61.

Goh CL, Abad-Casintahan F, Chow SKW, et al. Evaluating acne-related post-inflammatory hyperpigmentation is a challenge even amongst experts. J Dermatol. 2014;41(12):1106–8. https://doi.org/10.1111/1346-8138.12667.CrossRefPubMed

62.

Savory SA, Agim NG, Mao R, et al. Reliability assessment and validation of the Postacne Hyperpigmentation Index (PAHPI), a new instrument to measure postinflammatory hyperpigmentation from acne vulgaris. J Am Acad Dermatol. 2014;70(1):108–14. https://doi.org/10.1016/j.jaad.2013.09.017.CrossRefPubMed

63.

Taylor SC, Arsonnaud S, Czernielewski J, Hyperpigmentation Scale Study Group. The Taylor Hyperpigmentation Scale: a new visual assessment tool for the evaluation of skin color and pigmentation. Cutis. 2005;76(4):270–4.PubMed

64.

Kang BY, Ibrahim SA, Shokeen D, et al. Postinflammatory hyperpigmentation: protocol for development of a core outcome set for clinical trials. Arch Dermatol Res. 2021. https://doi.org/10.1007/s00403-021-02239-6. (Epub 2021 May 21).CrossRefPubMed

Title: Review of Laser Treatments for Post-Inflammatory Hyperpigmentation in Skin of Color
Authors: Madeleine Sowash
Tina Alster
Publication date: 13-02-2023
Publisher: Springer International Publishing
Keywords: Intense Pulsed Light
Hyperpigmentation
Tranexamic Acid
Acne
Laser
Published in: American Journal of Clinical Dermatology / Issue 3/2023
Print ISSN: 1175-0561
Electronic ISSN: 1179-1888
DOI: https://doi.org/10.1007/s40257-023-00759-7

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Review of Laser Treatments for Post-Inflammatory Hyperpigmentation in Skin of Color

Abstract

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

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